Risk factors for prosthetic joint infections following total hip arthro- plasty based on 33,337 hips in the Finnish Arthroplasty Register from 2014 to 2018

Authors

  • Keijo T Mäkelä Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku
  • Valtteri J Panula Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku
  • Kasperi J Alakylä Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku
  • Mikko S Venäläinen Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku
  • Jaason J Haapakoski National Institute for Health and Welfare, Helsinki
  • Antti P Eskelinen Coxa Hospital for Joint Replacement, Tampere
  • Mikko J Manninen Orton Hospital, Helsinki
  • Jukka S Kettunen Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio
  • Ari-Pekka Puhto Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu
  • Anna I Vasara Helsinki University Hospital, Helsinki, Finland
  • Laura L Elo urku Bioscience Centre, University of Turku and Åbo Akademi University, Turku

DOI:

https://doi.org/10.1080/17453674.2021.1944529

Abstract

Background and purpose — Periprosthetic joint infection (PJI) is a devastating complication and more informa- tion on risk factors for PJI is required to find measures to prevent infections. Therefore, we assessed risk factors for PJI after primary total hip arthroplasty (THA) in a large patient cohort.

Patients and methods — We analyzed 33,337 primary THAs performed between May 2014 and January 2018 based on the Finnish Arthroplasty Register (FAR). Cox proportional hazards regression was used to estimate hazard ratios with 95% confidence intervals (CI) for first PJI revision operation using 25 potential patient- and surgical- related risk factors as covariates.

Results — 350 primary THAs were revised for the first time due to PJI during the study period. The hazard ratios for PJI revision in multivariable analysis were 2.0 (CI 1.3– 3.2) for ASA class II and 3.2 (2.0–5.1) for ASA class III–IV compared with ASA class I, 1.4 (1.1–1.7) for bleeding > 500 mL compared with < 500 mL, 0.4 (0.2–0.7) for ceramic-on- ceramic bearing couple compared with metal-on-polyeth- ylene and for the first 3 postoperative weeks, 3.0 (1.6–5.6) for operation time of > 120 minutes compared with 45–59 minutes, and 2.6 (1.4–4.9) for simultaneous bilateral operation. In the univariable analysis, hazard ratios for PJI revi- sion were 2.3 (1.7–3.3) for BMI of 31–35 and 5.0 (3.5–7.1) for BMI of > 35 compared with patients with BMI of 21–25.

Interpretation — We found several modifiable risk factors associated with increased PJI revision risk after THA to which special attention should be paid preoperatively. In particular, high BMI may be an even more prominent risk factor for PJI than previously assessed.

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Author Biographies

Valtteri J Panula, Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku

Shared first authorship

Kasperi J Alakylä, Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku

Shared first authorship

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Additional Files

Published

2021-07-01

How to Cite

Mäkelä, K. T., Panula, V. J., Alakylä, K. J., Venäläinen, M. S., Haapakoski, J. J., Eskelinen, A. P., Manninen, M. J., Kettunen, J. S., Puhto, A.-P., Vasara, A. I., & Elo, L. L. (2021). Risk factors for prosthetic joint infections following total hip arthro- plasty based on 33,337 hips in the Finnish Arthroplasty Register from 2014 to 2018. Acta Orthopaedica, 92(6), 665–672 . https://doi.org/10.1080/17453674.2021.1944529