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. 2020 Jul 1;102(13):1160-1168.
doi: 10.2106/JBJS.18.01500.

Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place: What Should Be Done with the Silent Prosthetic Joints

George A Komnos  1 , Jorge Manrique  1   2 , Karan Goswami  1 , Timothy L Tan  1 , Camilo Restrepo  1 , Matthew B Sherman  1 , Javad Parvizi  1
Affiliations

Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place: What Should Be Done with the Silent Prosthetic Joints

George A Komnos et al. J Bone Joint Surg Am. .

Abstract

Background: Although periprosthetic joint infection (PJI) can affect multiple joints concurrently, the majority of patients with multiple prosthetic joints present with PJI of a single joint. Data regarding the optimal management of these patients are limited. We aimed to identify the prevalence, risk factors for a subsequent PJI, and clinical circumstances of PJI in patients with multiple prosthetic joints.

Methods: We retrospectively reviewed the clinical records of 197 patients with ≥2 total joint prostheses in place who presented with PJI from 2000 to 2017. The average follow-up was 3.6 years (range, 0.5 to 17 years). Demographic data and risk factors for synchronous or metachronous PJI were identified. The time from the initial to the second PJI and organism profile data were collected as well. The workup for other joints with a prosthesis in place at the time of the initial PJI was noted.

Results: Among the 197 patients with PJI and multiple joint prostheses in situ, 37 (19%) developed PJI in another joint; 11 had a synchronous PJI and 26 had a metachronous PJI. The average time between the first and the second infection in the metachronous cases was 848 days (range, 20 to 3,656 days). Females and patients with an initial PJI with methicillin-resistant Staphylococcus aureus (MRSA) were more likely to have a metachronous PJI, and patients with rheumatoid arthritis had an increased risk of a second (metachronous or synchronous) PJI. Three of 11 patients in the synchronous group and 19% (5) of the 26 in the metachronous group had bacteremia at the time of the initial PJI compared with 12% (19) of the 160 with a single PJI. The percentage of negative cultures increased from 10% for the initial PJIs to 38% for the metachronous PJIs.

Conclusions: Patients who have multiple prosthetic joints in place and present with PJI of a single joint are at risk of developing PJI in another joint. Female sex, rheumatoid arthritis, bacteremia at presentation, and infection with MRSA appear to be risk factors for PJI of another joint. Clinical evaluation of the other prosthetic joint(s) should be carried out in all patients and aspiration of those joint(s) should be considered for patients with any of the above risk factors.

Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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References

    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5.
    1. Shao Y, Zhang C, Charron KD, Macdonald SJ, McCalden RW, Bourne RB. The fate of the remaining knee(s) or hip(s) in osteoarthritic patients undergoing a primary TKA or THA. J Arthroplasty. 2013 Dec;28(10):1842-5.
    1. Wolff LH 3rd, Parvizi J, Trousdale RT, Pagnano MW, Osmon DR, Hanssen AD, Haidukewych GJ. Results of treatment of infection in both knees after bilateral total knee arthroplasty. J Bone Joint Surg Am. 2003 Oct;85(10):1952-5.
    1. Murray RP, Bourne MH, Fitzgerald RHJ Jr. Metachronous infections in patients who have had more than one total joint arthroplasty. J Bone Joint Surg Am. 1991 Dec;73(10):1469-74.
    1. Luessenhop CP, Higgins LD, Brause BD, Ranawat CS. Multiple prosthetic infections after total joint arthroplasty. Risk factor analysis. J Arthroplasty. 1996 Oct;11(7):862-8.