Prosthetic joint infection risk after TKA in the Medicare population

Abstract

The current risk of infection in contemporary total knee arthroplasty (TKA) as well as the relative importance of risk factors remains under debate as a result of the rarity of the complication and temporal changes in the treatment and prevention of infection. We therefore determined infection incidence and risk factors after TKA in the Medicare population. The Medicare 5% national sample administrative data set was used to identify and longitudinally follow patients undergoing TKA for deep infections and revision surgery between 1997 and 2006. Cox regression was used to evaluate patient and hospital characteristics. In 69,663 patients undergoing elective TKA, 1400 TKA infections were identified. Infection incidence within 2 years was 1.55%. The incidence between 2 and up to 10 years was 0.46%. Women had a lower risk of infection than men. Comorbidities also increased TKA infection risk. Patients receiving public assistance for Medicare premiums were at increased risk for periprosthetic joint infection (PJI). Hospital factors did not predict an increased risk of infection. PJI occurs at a relatively high rate in Medicare patients with the greatest risk of PJI within the first 2 years after surgery; however, approximately one-fourth of all PJIs occur after 2 years.

Level of evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

The effect of Charlson index on Kaplan-Meier survivorship after primary knee arthroplasty using diagnosis of a deep infection (996.66) as an end point.

Fig. 2

The effect of procedure duration on Kaplan-Meier survivorship after primary knee arthroplasty using diagnosis of a deep infection (996.66) as an end point.

Fig. 3

The effect of patient gender on Kaplan-Meier survivorship after primary knee arthroplasty using diagnosis of a deep infection (996.66) as an end point.