Risk Factors Associated with Revision for PJI after THA

    Researchers from the University of Bristol in the UK have identified the most important risk factors for periprosthetic joint infection (PJI) and revision surgery after primary total hip arthroplasty (THA):

    • Age under 60 years
    • Male
    • Chronic pulmonary disease
    • Diabetes
    • Higher body mass index

    The research also showed that some patients are at risk of early infection, while others are more prone to late infection after THA.

    The study was published in The Lancet Infectious Diseases and funded by the National Institute for Health Research (NIHR).

    The researchers from the University of Bristol’s the Musculoskeletal Research Unit used data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man linked to the Hospital Episode Statistics database to consider the risk of infection following primary THA. Their study included more than 600,000 primary THA patients, of whom 2705 underwent revision THA for PJI.

    The surgical approach used and the implant materials were found to influence the risk of revision surgery for PJI: Patients who had a primary THA through a posterior approach and those who received a ceramic bearing were less likely to be revised for an infection. Hip fracture patients who underwent THA were also at a higher risk of infection. Interestingly, the experience of the surgeon and the size of the orthopaedic center had no effect or only a small effect on the risk of revision for PJI.

    In addition, the research found that risk factors have varying effects on development of PJI during the postoperative period, with comorbidities such as dementia influencing early revision for PJI and liver diseases influencing long-term revision. This is an important factor to consider when conducting further research in this area, as just considering overall risk or short-term risk may mean important effects are missed.

    The risk of revision for PJI following primary THA is mainly driven by patient and surgical factors, the researchers said, and the potentially modifiable factors identified in this study should be considered by surgeons when recommending THA. It is equally important for clinicians to consider the factors that can’t be changed and the factors that exhibit time specific effects on the risk of PJI to support and inform patients appropriately preoperatively.

    The research team from the University of Bristol are also investigating whether similar patterns and risk factors are seen with primary total knee arthroplasty. They also intend to examine treatment of PJI to determine which treatment results in the best outcome for patients.


    Lenguerrand E, Whitehouse MR, Beswick AD, et al. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. Lancet Infect Dis. 2018 Jul 25. pii: S1473-3099(18)30345-1. doi: 10.1016/S1473-3099(18)30345-1. [Epub ahead of print].