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. 2025 Oct 15;107(20):2243-2250.
doi: 10.2106/JBJS.24.01630. Epub 2025 Aug 29.

Fifteen-Year Mortality Following Periprosthetic Joint Infection in Total Knee Arthroplasty: A Registry Study of 8,642 Revisions for Infection

Nicolai K Kristensen  1   2   3 , Jeppe Lange  1   3 , Richard de Steiger  4 , Michelle Lorimer  5 , Dylan Harries  5 , Ian A Harris  6   7 , Laurens Manning  8   9 , Peter Lewis  10   11   12 , David Campbell  11   12
Affiliations

Fifteen-Year Mortality Following Periprosthetic Joint Infection in Total Knee Arthroplasty: A Registry Study of 8,642 Revisions for Infection

Nicolai K Kristensen et al. J Bone Joint Surg Am. .

Abstract

Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication associated with notable loss of function, impaired quality of life, and excess short-term mortality. In this study, we aimed to report the impact of PJI on long-term mortality and its associated risk factors.

Methods: Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), we used Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables to describe mortality rates following revision for PJI, aseptic revisions (excluding those for fracture), and unrevised primary TKA. Additionally, hazard ratios (HRs) were calculated with multivariable proportional hazard models to assess the impact of the risk factors of age, gender, comorbidities, and minor versus major revisions.

Results: Among 867,113 TKA procedures overall, there were 8,642 first revisions for PJI and 25,328 aseptic first revisions. At 5, 10, and 15 years, 16.1%, 34.4%, and 53.4% of patients with revision for PJI had died. When compared with a matched population, the SMR for revision for PJI was 1.33 (95% confidence interval [CI]: 1.28 to 1.39); for aseptic revision, 0.84 (95% CI: 0.82 to 0.87); and for unrevised primary TKA, 0.79 (95% CI: 0.78 to 0.79). Increasing age and higher American Society of Anesthesiologists (ASA) scores were significant mortality risk factors. Major revisions for PJI were not associated with a greater mortality risk compared with minor revisions for PJI.

Conclusions: Patients with revision for PJI had a 33% greater-than-expected mortality. There was a high mortality in the early postoperative period, and the excess mortality risk persisted beyond 15 years. Increasing age and higher ASA scores were associated with increased mortality.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I799 ).

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