PJI Risk Increases in Patients Undergoing Aseptic Reoperation within 1 Year of THA
Preventing, diagnosing, and treating periprosthetic joint infection (PJI) is a concern for every orthopaedic surgeon who performs total joint arthroplasty – and with good reason:
- A rise in PJIs is inevitable given the significant increase in hip and knee replacement procedures projected to occur over the next decade. 
- That’s because the PJI rate does not seem to be declining despite the focus on prevention, although it may finally be leveling off, at least among high-volume surgeons. [2,3]
- Hospitals take a hit financially: The cost of revision procedures associated with infection rose from $320 million to $566 million between 2001 and 2009 and is projected to increase to more than $1.62 billion by 2020. 
- Patients who develop a PJI end up with a longer length of stay, delayed recovery, and the need for a revision procedure that puts them at risk for more complications.
As the literature makes clear, it is crucial for surgeons to understand why their patients could be at risk for PJI so that they can then take steps to reduce that risk.
At the 2019 AAHKS Annual Meeting, researchers from Mayo Clinic added to the discussion on risk factors surgeons need to consider: They presented data on the risk of PJI in the year following aseptic reoperation in primary total hip arthroplasty (THA) patients.
This research received the Lawrence D. Dorr Surgical Techniques & Technologies Award at the meeting.
Using data from the institution’s total joint registry, the researchers identified 213 THA patients who had undergone an aseptic reoperation within 1 year of the index procedure. Mean follow-up on these patients was 5 years.
The patients were divided into 2 groups:
- Reoperation 90 days or less after the index procedure (n=112), most commonly for instability, fracture, and hematoma/seroma
- Reoperation 91 days to 365 days after the index procedure (n=101), most commonly for instability, fracture, and aseptic loosening
At 2 years, the PJI rate was 4.7% for patients who had undergone aseptic reoperation within 90 days of the index procedure, compared with 3.1% at 2 years for patients who had undergone reoperation after 90 days but within 1 year of the index procedure.
These results were compared with a control group of 15,357 THA patients, also from the Mayo Clinic total joint registry, who had not undergone reoperation within 1 year of primary THA. These patients had a PJI rate of 0.2% at 2 years.
The researchers concluded that, “aseptic reoperations within the first year following primary THA lead to [an] 8- to 13-fold increased risk of subsequent PJI,” and that the risk was similar whether the reoperation occurred early or later within the year following surgery.
Goldman AH, Osmon D, Hanssen AD, Pagnano MW, Abdel MP. The Lawrence D. Dorr Surgical Techniques & Technologies Award. Aseptic Reoperations Within One Year of Primary Total Hip Arthroplasty Markedly Increase the Risk of Later Periprosthetic Joint Infection. Presented at the 2019 AAHKS Annual Meeting, November 7-9, 2019, in Dallas, Texas.
- Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5.
- Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. Are we winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the Medicare population. J Arthroplasty. 2018 Oct;33(10):3238-3245. doi: 10.1016/j.arth.2018.05.042. Epub 2018 Jun 1.
- Perfetti DC, Boylan MR, Naziri Q, Paulino CB, Kurtz CM, Mont MA. Have periprosthetic hip infection rates plateaued? J Arthroplasty. 2017 Jul;32(7):2244-2247. doi: 10.1016/j.arth.2017.02.027. Epub 2017 Feb 20.
- Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep;27(8 Suppl):61-5.e1. doi: 10.1016/j.arth.2012.02.022. Epub 2012 May 2.