Trends of Prosthetic Joint Infection Organisms and Recurrence for a Single High-Volume Arthroplasty Surgeon Over 20 Years

Caleb M Yeung; Vincentius J Suhardi; Nathan H Varady; Shane C Eizember; Paul M Lichstein; James H Maguire; Antonia F Chen; Daniel M Estok 2nd

doi:10.1016/j.arth.2020.10.002

Trends of Prosthetic Joint Infection Organisms and Recurrence for a Single High-Volume Arthroplasty Surgeon Over 20 Years

J Arthroplasty. 2021 Mar;36(3):1101-1108. doi: 10.1016/j.arth.2020.10.002. Epub 2020 Oct 13.

Authors

Caleb M Yeung¹, Vincentius J Suhardi¹, Nathan H Varady¹, Shane C Eizember¹, Paul M Lichstein¹, James H Maguire¹, Antonia F Chen¹, Daniel M Estok 2nd¹

Affiliation

¹ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.

PMID: 33160807
DOI: 10.1016/j.arth.2020.10.002

Abstract

Background: Prosthetic joint infection (PJI) is a morbid complication following total joint arthroplasty (TJA). PJI diagnosis and treatment has changed over time, and patient co-management with a high-volume musculoskeletal infectious disease (MSK ID) specialist has been implemented at our institution in the last decade.

Methods: We retrospectively evaluated all consecutive TJA patients treated for PJI between 1995 and 2018 by a single high-volume revision TJA surgeon. Microbial identities, antibiotic resistance, prior PJI, and MSK ID consultation were investigated.

Results: In total, 261 PJI patients (median age 66 years, interquartile range 57-75) were treated. One-year and 5-year reinfection rates were 15.8% (95% confidence interval [CI] 11.6-20.7) and 22.1% (95% CI 17.0-27.7), respectively. Microbial identities and antibiotic resistances did not change significantly over time. Despite seeing more prior PJI patients (53.3% vs 37.6%, P = .012), MSK ID-managed patients had similar infection rates as non-MSK ID-managed patients (hazard ratio [HR] 1.02, 95% CI 0.6-1.75, P = .93). Prior PJI was associated with higher reinfection risk (HR 2.39, 95% CI 1.39-4.12, P = .002) overall and in patients without MSK ID consultation, specifically (HR 2.78, 95% CI 1.37-5.65, P = .005). This risk was somewhat lower and did not reach significance in prior PJI patients with MSK ID consultation (HR 1.97, 95% CI 0.87-4.48, P = .106).

Conclusion: We noted minimal differences in microbial/antibiotic resistances for PJI over 20 years in a single institution, suggesting current standards of PJI treatment remain encouragingly valid in most cases. MSK ID involvement was not associated with lower reinfection risk overall; however, in patients with prior PJI, the risk of reinfection appeared to be somewhat lower with MSK ID involvement.

Level of evidence: Level IV-Case Series.

Keywords: antibiotic sensitivity; infection; prosthetic joint infection; total hip arthroplasty; total knee arthroplasty.

MeSH terms

Aged
Arthritis, Infectious*
Arthroplasty, Replacement, Hip* / adverse effects
Humans
Prosthesis-Related Infections* / epidemiology
Prosthesis-Related Infections* / etiology
Prosthesis-Related Infections* / surgery
Reoperation
Retrospective Studies
Risk Factors
Surgeons*