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Patients who develop periprosthetic joint infection (PJI) after total hip replacement have a fivefold increased risk of death over a ten-year period, according to new research.
The research findings were published in the Journal of Bone and Joint Surgery.
Researchers from ICES, Sunnybrook Research Institute and the Department of Surgery at the Temerty Faculty of Medicine at the University of Toronto examined the long-term (10-year) mortality risk of PJI for 175,432 adults who underwent their first hip replacement in Ontario, Canada. This is the largest study to date on patients with PJI after total hip arthroplasty (THA). ICES and Arthritis Society Canada provided funding for this study.
Approximately 1 in 7 Canadian adults suffer from osteoarthritis, a number expected to rise as baby boomers age and life expectancy increases. Joint replacement procedures can reduce pain and improve quality of life for people struggling with this progressive disease.
Also read: Delay in joint replacement surgery increases complications: Expert
Success Rate of Hip Replacement Surgery
“Most hip replacement surgeries are very successful, but unfortunately, approximately one to two percent of patients develop an infection in the artificial joint. It is well established that such infections impact long-term patient health, but this research provides strong evidence that they can also lead to death,” said lead author Dr. Raman Mundy, assistant professor in the Department of Surgery at Temerty Medicine and surgeon-scientist in the Department of Orthopaedic Surgery at Sunnybrook Health Sciences Centre.
The researchers found that among adults who received their first hip replacement from 2002 to 2021, 868 patients (0.5%) required further surgery for PJI within one year of hip replacement.
Patients with a PJI in the first year had a significantly higher 10-year mortality rate than those who did not develop an infection (11.4% vs. 2.2%)
“Our findings emphasize that arthroplasty surgeons and infectious disease specialists should work together on prevention efforts and follow best practice guidelines for patient care,” said senior author Dr. Bhishma Ravi, an assistant scientist at ICES, surgeon-scientist in the Department of Orthopaedic Surgery at Sunnybrook Health Sciences Centre and assistant professor of surgery at Temerty Medicine.
Also read: A new beginning: Patients may live longer after hip replacement surgery
The authors provide several reasons why they believe the relationship between PJI and mortality is probably causal, not correlational.
First, the association was strong enough that the authors controlled for variables such as age, sex, income, and health status. Second, there is precedent that major orthopedic events (for example, hip fractures) can directly increase the risk of mortality. And finally, this study builds on existing evidence using small groups of patients and short follow-up times.
“Ultimately, we need to develop effective strategies to prevent and treat these infections to reduce the long-term risks to patients,” Ravi said.
“Joint replacement surgery is the mainstay of definitive management for millions of patients suffering from end-stage osteoarthritis. Although the risk of infection is quite low for the individual patient, given that thousands of hip replacements are performed each year in Canada, and 70% are directly due to arthritis, finding strategies that reduce the risk of infection even further is important from a public health perspective. Funding this research has allowed us to quantify this risk and provides the data needed to inform future prevention strategies,” said Dr. Sian Bevan, Chief Science Officer for Arthritis Society Canada.
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