Short-term Complications After Revision Hip Arthroplasty for Prosthetic Joint Infection Are Increased Relative to Noninfectious Revisions

Jun 2, 2018The Journal of arthroplasty

Short-term problems after hip replacement surgery are higher when done for joint infection than for other reasons

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Abstract

Of 12,045 revision total hip arthroplasty (THA) procedures, 1,268 (10.5%) were performed for periprosthetic joint infection (PJI).

Patients undergoing revision THA for PJI had nearly four times the rate of total complications compared to those with primary THA.
The risk of sepsis was significantly higher in PJI revision patients, with an odds ratio of 13.15.
Deep surgical site infections were more prevalent in PJI revisions, with an odds ratio of 8.58.
Patients undergoing revision for PJI had a longer postoperative length of stay, averaging 3.0 additional days.
Compared to non-PJI revisions, PJI revisions also led to increased rates of readmissions and nonhome discharge.

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BACKGROUND: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is associated with significant morbidity and cost. The purpose of this study was to determine how rates of perioperative complications, operative duration, and postoperative length of stay (LOS) in patients undergoing revision THA for PJI compare to primary THA and to revision THA for non-PJI.

METHODS: We used the National Surgical Quality Improvement Program registry from 2005 to 2015 to identify all patients who underwent primary and revision THA. Patients were placed into cohorts based on the surgical procedure and by indication, including (1) primary THA, (2) revision THA for PJI, and (3) revision THA for non-PJI. Differences in 30-day postoperative medical complications, hospital readmissions, operative duration, and LOS were compared using bivariate and multivariate analyses.

RESULTS: One lakh fourteen thousand five hundred five THA patients were identified, with 102,460 (89.5%) patients undergoing a primary THA and 12,045 (10.5%) undergoing a revision procedure. Of the 12,045 revision procedures, 10,777 (89.5%) were for non-PJI indications and 1268 (10.5%) were for PJI. Relative to primary THA, patients undergoing revision THA for PJI had an increased rate of total complications (odds ratio [OR] 3.96), sepsis (OR 13.15), deep surgical site infections (SSIs, OR 8.58), superficial SSI (OR 2.14, P = .002), nonhome discharge (OR 1.85), readmissions (OR 2.46), LOS (+3.0 days), and operative duration (+61 minutes). Compared with non-PJI revisions, PJI revisions had an increased rate of total complications (OR 2.42), sepsis (OR 5.51), deep SSI (OR 2.12), nonhome discharge (OR 1.47), and LOS (+1.8 days).

CONCLUSION: Revision THA for PJI is associated with increased postoperative complications, nonhome discharge, and LOS relative to non-PJI revision THA. Separate care pathways and reimbursement bundles should be considered for patients with PJI.

LEVEL OF EVIDENCE: III.

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Short-term Complications After Revision Hip Arthroplasty for Prosthetic Joint Infection Are Increased Relative to Noninfectious Revisions

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