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. 2012 Oct;83(5):449-58.
doi: 10.3109/17453674.2012.733918.

Increasing risk of prosthetic joint infection after total hip arthroplasty

Håvard Dale  1 , Anne M Fenstad, Geir Hallan, Leif I Havelin, Ove Furnes, Søren Overgaard, Alma B Pedersen, Johan Kärrholm, Göran Garellick, Pekka Pulkkinen, Antti Eskelinen, Keijo Mäkelä, Lars B Engesæter
Affiliations

Increasing risk of prosthetic joint infection after total hip arthroplasty

Håvard Dale et al. Acta Orthop. 2012 Oct.

Abstract

Background and purpose: The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden).

Materials and methods: The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection as the endpoint. The effect of risk factors such as the year of surgery, age, sex, diagnosis, type of prosthesis, and fixation were assessed.

Results: 2,778 (0.6%) of the primary THAs were revised due to infection. Compared to the period 1995-1999, the relative risk (with 95% CI) of revision due to infection was 1.1 (1.0-1.2) in 2000-2004 and 1.6 (1.4-1.7) in 2005-2009. Adjusted cumulative 5-year revision rates due to infection were 0.46% (0.42-0.50) in 1995-1999, 0.54% (0.50-0.58) in 2000-2004, and 0.71% (0.66-0.76) in 2005-2009. The entire increase in risk of revision due to infection was within 1 year of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head necrosis. None of these risk factors increased in incidence during the study period.

Interpretation: We found increased relative risk of revision and increased cumulative 5-year revision rates due to infection after primary THA during the period 1995-2009. No change in risk factors in the NARA dataset could explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA.

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Figures

Figure 1.
Figure 1.
Adjusted cumulative revision rates for THAs revised due to infection in 3 time periods of primary surgery, for all THAs (upper left panel) and 5 subgroups of THAs. Adjusted for age, sex, diagnosis, prosthesis, and cement. *Adjusted for age and sex only.
Figure 2.
Figure 2.
Graphical display of the relationship between year of primary surgery and relative risk of revision due to infection (with 95% CI), for all THAs (upper left panel) and 5 subgroups of THAs. The broken lines represent no difference in relative risk from the beginning of the period (RR = 1). Adjusted for age, sex, diagnosis, prosthesis, and cement. *Adjusted for age and sex.
Figure 3.
Figure 3.
A graphical display of the relationship between relative risk of revision due to infection and time after primary THAs for the period 2000–2004 (left panel) and 2005–2009 (right panel) compared to 1995–1999 (blue lines). Smoothed Schoenfeld residuals adjusted for age, sex, diagnosis, prosthesis and cement (solid lines) with 95% confidence intervals (broken lines).
See this image and copyright information in PMC

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