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. 2024 Jul 5;11(3):e12083.
doi: 10.1002/jeo2.12083. eCollection 2024 Jul.

Key risk factors and adverse outcomes in metachronous vertebral osteomyelitis following periprosthetic joint infection: A 5-year retrospective study

Yu-Chih Lin  1   2   3 , An-Jhih Luo  1   2 , Fu-Cheng Kao  1   2   3 , An-Shun Tai  4 , Yuhan Chang  1   2   3 , Pang-Hsin Hsieh  1   2   3 , Sheng-Hsun Lee  1   2 , Sheng-Hsuan Lin  4
Affiliations

Key risk factors and adverse outcomes in metachronous vertebral osteomyelitis following periprosthetic joint infection: A 5-year retrospective study

Yu-Chih Lin et al. J Exp Orthop. .

Abstract

Purpose: Periprosthetic joint infection (PJI) is a leading cause of joint arthroplasty failure, potentially leading to critical complications like vertebral osteomyelitis (VO). The factors contributing to VO after PJI and the outcomes for these patients are not well understood. Our study aims to (1) identify risk factors for VO following PJI and (2) assess the clinical outcomes in these cases.

Methods: We included PJI patients treated surgically at our centre from January 2006 to December 2020, excluding those with simultaneous VO post-PJI. Our focus was on patients with VO occurring after PJI, monitored for at least 5 years. Analysis included patient comorbidities, PJI treatment approaches, pathogen identification and clinical outcomes.

Results: Of 1701 PJI cases, 21 (1.23%) developed VO. Key risk factors for VO post-PJI were identified: systemic inflammatory response syndrome, substance misuse, polymicrobial infection and undergoing at least three stages of resection arthroplasty (odds ratios: 1.86, 54.28, 52.33 and 31.88, respectively). Adverse outcomes were noted in VO patients, with recurrent VO in 6/21 and repeated PJIs in 18/21 cases.

Conclusions: Patients with PJI, especially those with certain risk factors, have an increased likelihood of developing VO and encountering negative outcomes. The potential role of bacteremia in the development of VO after PJI needs further exploration.

Level of evidence: Level III.

Keywords: clinical outcomes; metachronous vertebral osteomyelitis; periprosthetic joint infection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection and analysis flowchart. This figure outlines the process used to identify and analyse patients in our study conducted at our institute from 2006 to 2020. Starting with a base of 232,123 patients admitted during the study period, we narrowed our focus to 54,323 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) identified using specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) and ICD‐10 procedure codes. After further refinement based on ICD codes related to periprosthetic joint infection (PJI), we followed 1840 patients who completed their initial PJI treatment and were under regular follow‐up. The analysis included 21 patients who developed vertebral osteomyelitis (VO) post‐PJI and 1680 patients without VO. The study objectives were to compare demographic data, analyse risk factors for subsequent VO and assess the outcomes of PJI and VO.
See this image and copyright information in PMC

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