Revision for prosthetic joint infection following hip arthroplasty

Author(s): E. Lenguerrand , BSc(Hon), MSc, PhD ¹ , M. R. Whitehouse , BSc, MB ChB, MSc, PhD, FRCS ¹ , A. D. Beswick , BSc(Hon) ¹ , S. A. Jones , BSc(Hons), MB BCh, MRCS, MSc, FRCS ² , M. L. Porter , MB ChB, FRCS ³ , A. W. Blom* , MBChB, MD, PhD, FRCS ¹ ^,

Publication date (Electronic): 30 June 2017

Journal: Bone & Joint Research

Keywords: Prosthetic joint infection, Hip arthroplasty, Time trend, Registry

Read this article at

ScienceOpenPublisher PMC

Bookmark

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objectives

We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI.

Methods

We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression.

Results

We demonstrated a prevalence of revision THA due to prosthetic joint infection of 0.4/100 procedures following primary and 1.6/100 procedures following revision hip arthroplasty. The prevalence of revision due to PJI in the three months following primary hip arthroplasty has risen 2.3-fold (95% confidence interval (CI) 1.3 to 4.1) between 2005 and 2013, and 3.0-fold (95% CI 1.1 to 8.5) following revision hip arthroplasty. Over 1000 procedures are performed annually as a consequence of hip PJI, an increase of 2.6-fold between 2005 and 2013.

Conclusions

Although the risk of revision due to PJI following hip arthroplasty is low, it is rising and, coupled with the established and further predicted increased incidence of both primary and revision hip arthroplasty, this represents a growing and substantial treatment burden.

Cite this article: E. Lenguerrand, M. R. Whitehouse, A. D. Beswick, S. A. Jones, M. L. Porter, A. W. Blom. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 2017;6:391–398. DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

Periprosthetic joint infection increases the risk of one-year mortality.

Benjamin Zmistowski, Joseph A Karam, Joel Durinka … (2013)

Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.

0 comments Cited 176 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Increasing risk of prosthetic joint infection after total hip arthroplasty

Håvard Dale, Anne Fenstad, Geir Hallan … (2012)

Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection as the endpoint. The effect of risk factors such as the year of surgery, age, sex, diagnosis, type of prosthesis, and fixation were assessed. Results 2,778 (0.6%) of the primary THAs were revised due to infection. Compared to the period 1995–1999, the relative risk (with 95% CI) of revision due to infection was 1.1 (1.0–1.2) in 2000–2004 and 1.6 (1.4–1.7) in 2005–2009. Adjusted cumulative 5–year revision rates due to infection were 0.46% (0.42–0.50) in 1995–1999, 0.54% (0.50–0.58) in 2000–2004, and 0.71% (0.66–0.76) in 2005–2009. The entire increase in risk of revision due to infection was within 1 year of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head necrosis. None of these risk factors increased in incidence during the study period. Interpretation We found increased relative risk of revision and increased cumulative 5–year revision rates due to infection after primary THA during the period 1995–2009. No change in risk factors in the NARA dataset could explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA.

0 comments Cited 116 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome

I Byren, P. Bejon, B L Atkins … (2009)

Objectives We describe treatment failure rates by antibiotic duration for prosthetic joint infection (PJI) managed with debridement, antibiotics and implant retention (DAIR). Methods We retrospectively collected data from all the cases of PJI that were managed with DAIR over a 5 year period. Surgical debridement, microbiological sampling, early intravenous antibiotics and prolonged oral follow-on antibiotics were used. Results One hundred and twelve cases of PJI were identified. Twenty infections (18%) recurred during a mean follow-up of 2.3 years. The mean duration of antibiotic use was 1.5 years. Failure was more common after arthroscopic debridement, for previously revised joints and for Staphylococcus aureus infection. There were 12 failures after stopping antibiotics and 8 while on antibiotics [hazard ratio (HR) = 4.3, 95% confidence interval (CI) 1.4–12.8, P = 0.01]. However, during the first 3 months of follow-up, there were eight failures after stopping antibiotics and two while on antibiotics (HR = 7.0, 95% CI 1.5–33, P = 0.015). The duration of antibiotic therapy prior to stopping did not predict outcome. Conclusions PJI may be managed by DAIR. The risk of failure with this strategy rises after stopping oral antibiotics, but lengthening antibiotic therapy may simply postpone, rather than prevent, failure.

0 comments Cited 108 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

E. Lenguerrand: Role: Non-clinical Research Fellow

M. R. Whitehouse: Role: Consultant Senior Lecturer, (E. Lenguerrand and M. R. Whitehouse contributed equally to the work)

A. D. Beswick: Role: Non-clinical Research Fellow

S. A. Jones: Role: Consultant Senior Lecturer

M. L. Porter: Role: Consultant

A. W. Blom*: Role: Professor

Journal

Journal ID (nlm-ta): Bone Joint Res

Title: Bone & Joint Research

ISSN (Electronic): 2046-3758

Publication date Collection: June 2017

Publication date (Electronic): 30 June 2017

Volume: 6

Issue: 6

Pages: 391-398

Affiliations

[1 ]Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK

[2 ]Cardiff & Vale University Health Board, University Hospital Llandough, Penlan Road, Llandough, Penarth, Vale of Glamorgan, CF64 2XX, UK

[3 ]Centre for Hip Surgery, Wrightington Hospital, Lancashire, WN6 9EP, UK

Author notes

[*]A. W. Blom; email: ashley.blom@ 123456nbt.nhs.uk

Article

Publisher ID: 10.1302_2046-3758.66.BJR-2017-0003.R1

DOI: 10.1302/2046-3758.66.BJR-2017-0003.R1

PMC ID: 5492333

PubMed ID: 28642256

SO-VID: cda112d3-d036-4354-bc7a-58ce9d8f49fa

License:

This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.

Revision for prosthetic joint infection following hip arthroplasty : Evidence from the National Joint Registry

Read this article at

Abstract

Objectives

Methods

Results

Conclusions

Related collections

Decoding Infection and Transmission

Most cited references 25

Periprosthetic joint infection increases the risk of one-year mortality.

Increasing risk of prosthetic joint infection after total hip arthroplasty

One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 361

Cited by 44

Most referenced authors 305