According to new research, patients who experience a periprosthetic joint infection (PJI) following a total hip replacement have a five-fold greater risk of death within a ten-year period.
The findings of the research were published in the Journal
of Bone and Joint Surgery.
Researchers from ICES, Sunnybrook Research Institute, and
the Department of Surgery at the Temerty Faculty of Medicine at the University
of Toronto examined the long-term (10 year) mortality risk of PJI for 175,432
adults receiving their first hip replacement in Ontario, Canada. This is one of
the largest studies to date of patients with PJI following total hip
arthroplasty (THA). ICES and Arthritis Society Canada provided funding for this
study.
About 1 in 7 Canadian adults live with osteoarthritis, a
number that is expected to grow as baby boomers age and life expectancies
increase. Joint replacement procedures can lessen pain and improve quality of
life for people who are dealing with this progressive disease.
"Most hip replacement surgeries are very successful,
but unfortunately, about one to two percent of patients develop infections of
the prosthetic joint. It is well established that such infections impact
patient health over the long-term, but this research provides compelling evidence
that it can even lead to death," said lead author Dr. Raman Mundi, an
assistant professor in Temerty Medicine's Department of Surgery and a
surgeon-scientist in the Division of Orthopaedic Surgery at Sunnybrook Health
Sciences Centre.
The researchers found that among adults receiving their
first hip replacement from 2002 to 2021, 868 patients (0.5%) required further
surgery for a PJI within one year of hip replacement.
Patients with a PJI within the first year had a
significantly higher 10-year mortality rate than those who didn't develop an
infection (11.4 per cent versus 2.2 per cent)
"Our findings underscore the need for arthroplasty
surgeons and infectious disease experts to work together on prevention efforts
and follow best practice guidelines for patient care," said senior author
Dr. Bheeshma Ravi, an adjunct scientist with ICES, surgeon-scientist with the
Division of Orthopaedic Surgery at Sunnybrook Health Sciences Centre and
assistant professor of surgery at Temerty Medicine.
The authors provide several reasons for why they believe the
association between PJI and mortality is likely causal and not correlational.
First is that the association was quite strong, with the
authors controlling for variables such as age, sex, income and health status.
Second is that there is precedent that major orthopaedic events (for example,
hip fractures) can directly increase risk of mortality. And finally, this study
builds on existing evidence that used smaller cohorts of patients and shorter
follow-up times.
"Ultimately, we need to develop effective strategies to
prevent and cure these infections to reduce the long-term risk to
patients," added Ravi.
"Joint replacement surgery is the mainstay of
definitive management for millions of patients living with end-stage osteoarthritis.
Although the risk of infection is quite low for the individual patient, given
that tens of thousands of hip replacements are performed annually in Canada,
and 70% are directly due to arthritis, it is crucial from a public health
perspective to find strategies that reduce infection risk even further. Funding
this research has allowed us to quantify this risk and provides necessary data
to inform future prevention strategies," said Dr
Sian Bevan, Chief Science Officer at Arthritis Society Canada.
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