Trends in Revision Hip Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 423 Hips at a High-Volume Center between 2008 and 2021

Abstract

<p>BACKGROUND: Prosthetic joint infection (PJI) is one of the most devastating complications after total hip arthroplasty (THA), and comorbidities increase the risk. We examined whether there was a temporal change in the demographics, especially regarding comorbidities, of patients who have PJIs and were treated over a 13-year study period at a high-volume academic joint arthroplasty center. In addition, the surgical methods used and the microbiology of the PJIs were assessed.</p><p>METHODS: Revisions (n=423, 418 patients) due to PJI of the hip performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and implant retention, one-stage revision, and two-stage revision. Infections were classified as early, acute hematogenous and chronic infections.</p><p>RESULTS: There was no change in the median age of the patients, but the proportion of ASA-class 4 patients increased from 10.5 to 20%. The incidence of early infections increased from 0.11 per 100 primary-THAs in 2008 to 1.09 in 2021. The incidence of one-stage revisions increased the most, rising from 0.10 per 100 primary-THAs in 2010 to 0.91 per 100 primary-THAs in 2021. Furthermore, the proportion of infections caused by Staphylococcus aureus increased from 26.3% in 2008 to 2009 to 40% in 2020 to 2021.</p><p>CONCLUSIONS: The comorbidity burden of PJI patients increased during the study period. This increase may present a treatment challenge, as comorbidities are known to have a negative effect on PJI treatment outcomes.</p>