JOA - 2026-03-28 - Journal Article
High Mortality in Patients Presenting with Periprosthetic Joint Infection and Concomitant Sepsis.
Tran DH, Yang KJ, Ha JH, Hand R, Schmitt DR, Brown N
Topics
Key Takeaway
PJI patients presenting with concomitant sepsis had 81.4% all-cause mortality during follow-up versus 50.6% in non-septic PJI patients, with hip sepsis patients reaching only 42% one-year survival.
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Summary
This study examined all-cause mortality in PJI patients presenting with versus without concomitant sepsis at a single academic center over 17 years. Sepsis was defined by ≥2 SIRS criteria plus suspected or confirmed bacteremia. One-year survival for septic hip patients was 42% versus 93% for non-septic hip patients; each 10-year age increment increased mortality risk 29% in hip patients (HR=1.29) and 44% in knee patients (HR=1.44).
Key Limitation
Single-center retrospective design with no standardized treatment protocol documented, meaning variation in surgical timing, antibiotic regimen, and ICU management confounds the mortality signal attributed to sepsis itself.
Original Abstract
BACKGROUND
Periprosthetic joint infection (PJI) has a five-year mortality rate comparable to many cancers and can progress to life-threatening sepsis. The aim of this study was to investigate the mortality of patients presenting with simultaneous PJI and sepsis after hip and knee arthroplasty.
METHODS
A retrospective chart review was performed on patients from an academic center between 2005 and 2022. Patients who underwent total joint arthroplasty (TJA), developed PJI, and presented for revision were identified. Septic patients met two or more systemic inflammatory response syndrome criteria and had suspected or confirmed bacteremia. The study included 306 admitted patients who had PJI. On admission, 43 patients (14%) had sepsis, while 263 did not (85.9%). The analysis was divided by knee or hip procedure, with 121 hip patients and 185 knee patients. Patient demographics, comorbidities, complications, and follow-up data were collected. Descriptive and univariate statistical analyses were conducted.
RESULTS
The all-cause mortality rate during follow-up was 35 of 43 (81.4%) in patients who presented with sepsis versus 133 of 263 (50.6%) in patients who presented without sepsis. The estimated probability of survival up to one year for septic patients was 77% (95% confidence interval (CI): 63 to 94) versus 92% for non-septic patients (95% CI: 87 to 96) for knee patients and 42% (95% CI: 23 to 81) versus 93% (95% CI: 89 to 98) for hip patients. Each 10-year increase in age at time of admission is associated with a 29% increase in the risk of all-cause mortality (HR = 1.29, 95% CI: 1.08 to 1.45; P =0.005) for hip patients and a 44% increase for knee patients (HR=1.44 95% CI: 1.25 to 1.64; P = 0.000007).
CONCLUSION
Simultaneous PJI and sepsis is associated with a high mortality rate, even after adjusting for age and comorbidities.