5 Indicators of Synchronous Periprosthetic Joint Infection

Although rare, periprosthetic joint infection (PJI) after joint replacement can cause serious complications especially when found in more than one joint.

A new study, “Synchrononous Periprosthetic Joint Infection: The Need for All Artificial Joints to Be Aspirated Routinely,” published this past December in The Journal of Bone and Joint Surgery has identified five indicators of synchronous periprosthetic joint infections.

According to Infectious Disease Advisor, about 4 million hips and knees are expected to be replaced by 2030. Infection develops in almost 2% of all knee and hip replacements and can occur over the lifetime of the artificial joint. Treatment typically involves antimicrobials and surgical intervention.

The researchers in this study found that 2,532 septic revision procedures had to be performed on 1,508 prosthetic joints. Overall 644 patients were involved in the study, 26 had synchronous periprosthetic joint infection and 618 had non-synchronous periprosthetic joint infection.

According to their analysis, synchronous periprosthetic joint infection was associated with:

1. a suspicious clinical presentation of the non-primary joint (OR,5 [95% CI, 22.4 to 152.8]),
2. a history of neoplasia (OR, 12 [95% CI, 3.9 to 37.2]),
3. the use of immune-modulating therapy (OR, 9.5 [95% CI, 3.4 to 26.2]),
4. the presence of systemic inflammatory response syndrome or sepsis (OR, 8.4 [95% CI, 2.8 to 25]),
5. having 3 or more prosthetic joints (OR, 3.0 [95% CI, 1.37 to 6.64)]

The researchers wrote that surgeons need to be extra vigilant about these risk factors for synchronous periprosthetic joint infection and that “in the case of [periprosthetic joint infection], aspiration of each joint that had undergone total joint arthroplasty should be considered”.