JOA - 2026-07-11 - Journal Article
Preoperative Sepsis Is Associated with an Elevated Rate of Periprosthetic Joint Infection and Mortality Following Total Hip Arthroplasty in a Time-Dependent Manner.
Alhankawi AR, Holle AM, Renfree SP, Braithwaite CL, Verhey JT, Deckey DG, Bingham JS
Topics
Key Takeaway
Preoperative sepsis within 2 years of THA increases 2-year PJI risk (OR 1.4), mortality (OR 1.5), and dislocation (OR 1.3), with PJI and mortality risk persisting up to 1 year post-sepsis.
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Summary
This study evaluated whether preoperative sepsis within 2 years of elective primary THA increases medical and surgical complication rates, using a national insurance database with propensity score-matched controls (1:3 ratio). At 90 days, preoperative sepsis elevated rates of PJI (OR 1.4), postoperative sepsis (OR 3.6), pneumonia (OR 2.1), UTI (OR 1.8), AKI (OR 1.4), readmission (OR 1.3), and wound dehiscence (OR 1.4). Risk was time-dependent: AKI, DVT, and readmission were confined to sepsis within 6 months, while PJI and mortality remained elevated with sepsis up to 1 year prior; Gram-positive sepsis specifically drove PJI (OR 2.1) and periprosthetic fracture (OR 1.8) risk.
Key Limitation
The total sample size is unreported and reliance on insurance claims data precludes adjustment for sepsis severity (e.g., SOFA score), source control, or residual immune dysfunction markers, which are the most clinically relevant determinants of operative risk.
Original Abstract
BACKGROUND
Patients who have sepsis often experience persistent immune system and physiological dysregulation. However, the impact of preoperative sepsis on outcomes following elective total hip arthroplasty (THA) remains poorly defined. Thus, the purpose of this study was to evaluate the impact of preoperative sepsis on medical and surgical complications following primary THA, with attention to timing and etiology of sepsis in relation to adverse outcomes at 90 days and two years postoperatively.
METHODS
A retrospective cohort study was performed using a national insurance database. Patients diagnosed with sepsis within two years prior to THA were propensity score matched 1:3 to controls. Sepsis was stratified by timing (less than three months, three to six months, six to 12 months, 12 to 18 months, and 18 to 24 months preoperatively) and by etiology. Medical and surgical complications were assessed at 90 days and two years. Statistical significance was set at P < 0.05.
RESULTS
Preoperative sepsis was associated with increased 90-day rates of periprosthetic joint infection (odds ratio (OR) 1.4), postoperative sepsis (OR 3.6), acute kidney injury (OR 1.4), urinary tract infection (OR 1.8), pneumonia (OR 2.1), readmission (OR 1.3), and wound dehiscence (OR 1.4). At two years, rates of periprosthetic joint infection (OR 1.4), dislocation (OR 1.3), and mortality (OR 1.5) were elevated. Acute kidney injury, deep vein thrombosis, and readmission were increased when sepsis occurred within six months of THA, whereas periprosthetic joint infection and mortality remained elevated when sepsis occurred within one year. Gram-positive sepsis was associated with prosthetic joint infection (OR 2.1) and periprosthetic fracture (OR 1.8), while Gram-negative sepsis was associated with urinary tract infection (OR 2.6) (all findings P < 0.05).
CONCLUSION
Sepsis within two years prior to THA was associated with increased medical and surgical complications, with time-dependent risk patterns influencing postoperative outcomes.