JOA - 2026-08-24 - Journal Article
Incidence and Risk Factors for Periprosthetic Joint Infection in Patients Undergoing Primary Total Joint Arthroplasty Who have a History of Surgically Treated Periprosthetic Joint Infection in Another Joint.
Constantinescu D, Graham S, Dombrowsky A, Chandler C, Hietpas K, Otero JE
Topics
Key Takeaway
Primary TJA in patients with a prior surgically treated PJI in another joint carries a 1.5% one-year PJI incidence, statistically equivalent to controls (P=0.25), though prior exchange arthroplasty (vs. DAIR) confers higher risk (2.2% vs. 0%).
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Summary
This study asked whether patients with a prior surgically treated PJI in one joint face elevated PJI risk when undergoing primary TJA in a different joint. Using an institutional database (2010–2023), patients treated with DAIR or one-/two-stage revision for PJI were followed after subsequent primary THA or TKA. The one-year PJI incidence was 1.5%, not significantly different from controls (P=0.25), though prior exchange arthroplasty carried a 2.2% rate versus 0% for prior DAIR, and polymicrobial organisms predominated.
Key Limitation
The total sample size is not reported in the abstract, raising concern that the study is underpowered to detect a statistically significant difference in PJI incidence between the prior-PJI and control cohorts given the low baseline event rate.
Original Abstract
BACKGROUND
Patients who have a history of treated prosthetic joint infection (PJI) in total joint arthroplasty (TJA) may represent a high-risk population for repeat PJI when undergoing another primary TJA. The purpose of this study was to determine the incidence of PJI following primary total hip or knee arthroplasty in patients who had a history of surgically treated PJI in another joint and to identify risk factors associated with subsequent infection.
METHODS
We performed a retrospective secondary analysis of patients who underwent primary total hip or knee arthroplasty after prior treatment of PJI in another hip or knee joint with debridement, antibiotics, and implant retention (DAIR) or one- or two-stage revision. Patients were identified from an institutional database between 2010 and 2023. The primary outcome was subsequent PJI, evaluated by treatment strategy and patient factors. Demographics, comorbidities, surgical variables, microbiology, and timing between procedures were collected.
RESULTS
The incidence of PJI after one year in primary TJA in patients who had a history of treated PJI was 1.5%. We did not observe a higher risk of PJI in comparison with the control cohort (P = 0.25). Those treated with one- or two-stage exchange were at higher risk (2.2%) versus prior treatment with DAIR (zero). Patients who had a history of PJI had a higher comorbidity burden than controls, with a significantly greater proportion of McPherson Type B and C hosts (P < 0.0001). Polymicrobial infections were most common.
CONCLUSIONS
Patients who had a history of PJI undergoing subsequent primary TJA in another joint have a higher comorbidity burden than control TJA patients. Nevertheless, when appropriately optimized, they can safely undergo TJA with a low infection risk comparable to controls at one year. Medical optimization should be pursued to maximize outcomes in these challenging patients.