Abstract
Background
Prosthetic hip and knee joint infections (PJIs) are challenging to eradicate despite prosthesis removal and antibiotic therapy. There is a need to understand risk factors for PJI treatment failure in the setting of prosthesis removal.
Methods
A retrospective cohort of individuals who underwent prosthesis removal for a PJI at 5 hospitals in Toronto, Canada, from 2010 to 2014 was created. Treatment failure was defined as recurrent PJI, amputation, death, or chronic antibiotic suppression. Potential risk factors for treatment failure were abstracted by chart review and assessed using a Cox proportional hazards model.
Results
A total of 533 individuals with prosthesis removal were followed for a median (interquartile range) of 814 (235–1530) days. A 1-stage exchange was performed in 19% (103/533), whereas a 2-stage procedure was completed in 88% (377/430). Treatment failure occurred in 24.8% (132/533) at 2 years; 53% (56/105) of recurrent PJIs were caused by a different bacterial species. At 4 years, treatment failure occurred in 36% of 1-stage and 32% of 2-stage procedures (P = .06). Characteristics associated with treatment failure included liver disease (adjusted hazard ratio [aHR], 3.12; 95% confidence interval [CI], 2.09–4.66), the presence of a sinus tract (aHR, 1.53; 95% CI, 1.12–2.10), preceding debridement with prosthesis retention (aHR, 1.68; 95% CI, 1.13–2.51), a 1-stage procedure (aHR, 1.72; 95% CI, 1.28–2.32), and infection due to Gram-negative bacilli (aHR, 1.35; 95% CI, 1.04–1.76).
Conclusions
Failure of PJI therapy is common, and risk factors are not easily modified. Improvements in treatment paradigms are needed, along with efforts to reduce orthopedic surgical site infections.
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Details
1 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
2 Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
3 Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
4 Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada; Musculoskeletal Centre of Excellence, University of Toronto, Toronto, Ontario, Canada
5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
6 Unity Health Network, University of Toronto, Toronto, Ontario, Canada
7 North York General Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
8 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
9 Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Unity Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Orthopedics, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
10 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Orthopedics, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
11 Physician Assistant Program, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
12 Department of Microbiology, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
13 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sinai Health System, University of Toronto, Ontario, Canada