Association Between Periprosthetic Joint Infection and Mortality Following Primary Total Hip Arthroplasty

Raman Mundi; Daniel Pincus; Emil Schemitsch; Seper Ekhtiari; J Michael Paterson; Harman Chaudhry; Jerome A Leis; Donald A Redelmeier; Bheeshma Ravi

doi:10.2106/JBJS.23.01160

Association Between Periprosthetic Joint Infection and Mortality Following Primary Total Hip Arthroplasty

J Bone Joint Surg Am. 2024 May 9. doi: 10.2106/JBJS.23.01160. Online ahead of print.

Authors

Raman Mundi^{1

2}, Daniel Pincus^{1

2

3}, Emil Schemitsch⁴, Seper Ekhtiari⁵, J Michael Paterson^{3

6}, Harman Chaudhry^{1

2}, Jerome A Leis⁷, Donald A Redelmeier^{8

9}, Bheeshma Ravi^{1

2

3}

Affiliations

¹ Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
² Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
³ ICES, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁴ Department of Surgery, University of Western Ontario, London, Ontario, Canada.
⁵ Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom.
⁶ Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁷ Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, and Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.
⁸ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁹ Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.

PMID: 38723055
DOI: 10.2106/JBJS.23.01160

Abstract

Background: Periprosthetic joint infection (PJI) remains a dreaded and unpredictable complication after total hip arthroplasty (THA). In addition to causing substantial morbidity, PJI may contribute to long-term mortality risk. Our objective was to determine the long-term mortality risk associated with PJI following THA.

Methods: This population-based, retrospective cohort study included adult patients (≥18 years old) in Ontario, Canada, who underwent their first primary elective THA for arthritis between April 1, 2002, and March 31, 2021. The primary outcome was death within 10 years after the index THA. Mortality was compared between propensity-score-matched groups (PJI within 1 year after surgery versus no PJI within 1 year after surgery) with use of survival analyses. Patients who died within 1 year after surgery were excluded to avoid immortal time bias.

Results: A total of 175,432 patients (95,883 [54.7%] women) with a mean age (and standard deviation) of 67 ± 11.4 years underwent primary THA during the study period. Of these, 868 patients (0.49%) underwent surgery for a PJI of the replaced joint within 1 year after the index procedure. After matching, patients with a PJI within the first year had a significantly higher 10-year mortality rate than their counterparts (11.4% [94 of 827 patients] versus 2.2% [18 of 827 patients]; absolute risk difference, 9.19% [95% confidence interval (CI), 6.81% to 11.6%]; hazard ratio, 5.49 [95% CI, 3.32 to 9.09]).

Conclusions: PJI within 1 year after surgery is associated with over a fivefold increased risk of mortality within 10 years. The findings of this study underscore the importance of prioritizing efforts related to the prevention, diagnosis, and treatment of PJIs.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.