Prosthetic joint infection after total hip arthroplasty: Previous infection, seasonal variation and risk of second revision following prosthetic joint infection

Rajzan Joanroy*

*Corresponding author for this work

Research output: ThesisPh.D. thesis

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Abstract

Osteoarthritis (OA) of the hip, a degenerative condition, can occur in the aging population. OA involves gradual breakdown of cartilage and narrowing of the joint space, and the conditions causes pain and stiffness and reduces mobility. When conservative treatments fail, total hip arthroplasty (THA) may be recommended. THA is a common and successful orthopaedic procedure performed worldwide, benefiting patients with conditions like OA, fractures and hip diseases. However, it is not without risks as complications can necessitate revision surgery. Revision surgery is performed to address complications, such as prosthetic joint infection (PJI), which can have serious implications for patients and increases healthcare costs. Revision surgery due to PJI leads to prolonged hospital stays, increased re-admissions and potential complications, including subsequent revisions and possibly increased risk of mortality. Identifying modifiable risk factors and taking preventive measures before planned THA are essential to reduce the risk of PJI. The impaction of general previous infection is important to investigate as some patients may be more prone to infections. Preventive measures and strategies must therefore be developed to reduce the risk of PJI. In this scenario, the seasonality of PJI rates is a potentially overlooked factor. Some studies have suggested a link between higher PJI rates during the summer, possibly due to climate-related factors. However, more research with larger sample sizes and comprehensive analyses is needed to fully understand this association.

Study I
The aim was to investigate the association between any previous hospital-diagnosed or community-treated infection up to 6 months before primary THA and the risk of revision due to PJI, any revision and revision due to aseptic loosening. A cohort of 58,449 patients were included of whom 1,507 underwent a revision at 1-year followup. Of these, 536 revisions were due to PJI. No association was observed between previous general infection 0 to 6 months before primary THA and the risk of revision due to PJI. However, the risk of revision due to PJI was associated with increased risk of any revision.

Study II
The aim was to investigate the association between season of primary THA and the risk of revision due to PJI, any revision and revision due to aseptic loosening in a Northern European climate. A cohort of 58,449 patients were included of whom 1,507 underwent a revision at 1-year follow-up. Of these, 536 revisions were due to PJI. No association was observed between primary THA performed during the summer and rest of the year and the risk of revision due to PJI, any revision or aseptic loosening.

Study III
The aim was to investigate the risk of any second revision, second revision due to PJI and mortality following first-time revision due to PJI after primary THA. A cohort of 1,669 patients were included who underwent first-time revision due to PJI or non-PJI with a follow-up of up to 10 years. A total of 357 patients underwent second revision and a total of 287 patients died during the study period. There is a significantly increased risk of any second revision following a first-time revision due to PJI compared with non-PJI. However, the 10 year mortality risk was not increased following first-time revision due to PJI compared with non-PJI.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Varnum, Claus, Principal supervisor
  • Overgaard, Søren, Co-supervisor
  • Møller, Jens Kjølseth, Co-supervisor
  • Gubbels, Sophie, Co-supervisor, External person
Date of defence26. Jan 2024
Publisher
DOIs
Publication statusPublished - 4. Jan 2024

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