Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 19;28(1):177.
doi: 10.1186/s40001-023-01138-y.

Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients

Filippo Migliorini  1   2 , Christian David Weber  3 , Andreas Bell  4 , Marcel Betsch  5 , Nicola Maffulli  6   7   8 , Vanessa Poth  3 , Ulf Krister Hofmann  3 , Frank Hildebrand  3 , Arne Driessen  3
Affiliations

Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients

Filippo Migliorini et al. Eur J Med Res. .

Abstract

Introduction: The management of periprosthetic joint infections (PJI) of the lower limb is challenging, and evidence-based recommendations are lacking. The present clinical investigation characterized the pathogens diagnosed in patients who underwent revision surgery for PJI of total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: The present study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The institutional databases of the RWTH University Medical Centre of Aachen, Germany, were accessed. The OPS (operation and procedure codes) 5-823 and 5-821 and the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8 were used. All patients with PJI of a previous THA and TKA who underwent revision surgery were retrieved and included for analysis.

Results: Data from 346 patients were collected (181 THAs and 165 TKAs). 44% (152 of 346 patients) were women. Overall, the mean age at operation was 67.8 years, and the mean BMI was 29.2 kg/m2. The mean hospitalization length was 23.5 days. 38% (132 of 346) of patients presented a recurrent infection.

Conclusion: PJI remain a frequent cause for revisions after total hip and knee arthroplasty. Preoperative synovial fluid aspiration was positive in 37%, intraoperative microbiology was positive in 85%, and bacteraemia was present in 17% of patients. Septic shock was the major cause of in-hospital mortality. The most common cultured pathogens were Staph. epidermidis, Staph. aureus, Enterococcus faecalis, and Methicillin-resistant Staph aureus (MRSA). An improved understanding of PJI pathogens is important to plan treatment strategies and guide the choice of empirical antibiotic regimens in patients presenting with septic THAs and TKAs.

Level of evidence: Level III, retrospective cohort study.

Keywords: Arthroplasty; Hip; Infection; Knee; Mortality; Pathogens.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
STROBE diagram of the patient recruitment
See this image and copyright information in PMC

References

    1. Migliorini F, Driessen A, Oliva F, Maffulli GD, Tingart M, Maffulli N. Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in patients older than 50 years. J Orthop Surg Res. 2020;15(1):545. doi: 10.1186/s13018-020-02079-6. - DOI - PMC - PubMed
    1. Migliorini F, Maffulli N, Trivellas M, Eschweiler J, Hildebrand F, Betsch M. Total hip arthroplasty compared to bipolar and unipolar hemiarthroplasty for displaced hip fractures in the elderly: a Bayesian network meta-analysis. Eur J Trauma Emerg Surg. 2022 doi: 10.1007/s00068-022-01905-2. - DOI - PMC - PubMed
    1. Grimberg A, Jansson VWD, Lützner J, Melsheimer O, Morlock M, Steinbrück A. Endoprothesenregister Deutschland, Jahresbericht 2020. 2020.
    1. Statistisches Bundesamt. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern (4-Steller) für das Jahr 2019. 2020; 1–62
    1. Statistisches Bundesamt. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern (4-Steller) für das Jahr 2016. 2017