Does PJI after TJA Put Patients At Risk for Another PJI after Replacement of a Different Joint?

    Surgeons should use caution and thoroughly counsel patients who had a previous infected total joint arthroplasty when considering a subsequent joint replacement procedure.


    Timothy B. Rapp, MD


    Bedair H, Goyal N, Dietz MJ, Urish K, Hansen V, Manrique J, Hamilton W, Deirmengian G. A history of treated periprosthetic joint infection increases the risk of subsequent different site infection. Clin Orthop Relat Res. 2015 Feb 11. [Epub ahead of print]


    In this multi-center, retrospective cohort study, the authors found an increased rate of periprosthetic joint infection (PJI) in patients undergoing primary total joint arthroplasty after being successfully treated for PJI following replacement of a different joint.

    The research group from 4 academic institutions did a 1-to-1 match of patients who had no history of infection after primary arthroplasty with patients who were successfully treated for a PJI after arthroplasty. All patients subsequently underwent replacement of a different joint.

    Ten of the 90 patients with a previously treated PJI developed a PJI in the newly operated on joint, compared with 0 of 90 patients in the control group. The relative risk was 21.0, with a 95% confidence interval of 1.25-353.08 and p 0.035.

    Clinical Relevance

    Once a patient has had a knee or hip replaced, he or she will probably have the contralateral joint replaced as well. So it is not uncommon for patients to undergo multiple joint replacement surgeries.

    Although it is well known that patients who develop a PJI are at higher risk of another PJI in that same joint, the risk of developing an infection in a different joint in a subsequent replacement procedure is less well studied.

    This multicenter retrospective study shows that even after successful treatment of a PJI, patients are at a statistically significant higher risk of developing a PJI should they undergo arthroplasty procedures on different joints in the future.

    Because of this, providers should use caution and thoroughly counsel patients who have had a previous total joint arthroplasty that became infected when considering a subsequent joint replacement procedure.

    Author Information

    Timothy B. Rapp, MD, is Associate Professor and Chief of the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, NYU Langone Medical Center – Hospital for Joint Disease, New York, New York.