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Javad Parvizi - One of the best experts on this subject based on the ideXlab platform.
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Exhibit Selection Management of Periprosthetic Joint Infection: The Current Knowledge AAOS Exhibit Selection
2020Co-Authors: Javad Parvizi, Benjamin Zmistowski, Bahar Adeli, Camilo Restrepo, Alan Seth GreenwaldAbstract:Periprosthetic Joint Infection continues to frustrate the medical community. Although the demand for total Joint arthroplasty is increasing, the burden of such Infections is increasing even more rapidly, and they pose a unique challenge because their accurate diagnosis and eradication can prove elusive. This review describes the current knowledge re- garding diagnosis and treatment of Periprosthetic Joint Infection. A number of tools are available to aid in establishing a diagnosis of Periprosthetic Joint Infection. These include the erythrocyte sedimentation rate, serum C-reactive protein concentration, synovial white blood-cell count and differential, imaging studies, tissue specimen culturing, and histo- logical analysis. Multiple definitions of Periprosthetic Joint Infection have been proposed but there is no consensus. Tools under investigation to diagnose such Infections include the C-reactive protein concentration in the Joint fluid, point-of-care strip tests for the leukocyte esterase concentration in the Joint fluid, and other molecular markers of Periprosthetic Joint Infection. Treatment options include irrigation and debridement with prosthesis retention, one-stage prosthesis ex- change, two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer, and salvage treat- ments such as Joint arthrodesis and amputation. Treatment selection is dependent on multiple factors including the timing of the symptom onset, patient health, the infecting organism, and a history of Infection in the Joint. Although prosthesis retention has the theoretical advantages of decreased morbidity and improved return to function, two-stage exchange provides a lower rate of recurrent Infection. As the burden of Periprosthetic Joint Infection increases, the orthopaedic and medical community should become more familiar with the disease. It is hoped that the tools currently under investigation will aid clinicians in diagnosing Periprosthetic Joint Infection in an accurate and timely fashion to allow appropriate treatment. Given the current knowledge and planned future research, the medical community should be prepared to effectively manage this increasingly prevalent disease.
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Conventional diagnostic challenges in Periprosthetic Joint Infection.
The Journal of the American Academy of Orthopaedic Surgeons, 2020Co-Authors: Scott R Nodzo, Thomas Bauer, Paul S Pottinger, Grant E Garrigues, Hany Bedair, Carl A Deirmengian, John Segreti, Kevin J Blount, Imran M Omar, Javad ParviziAbstract:Periprosthetic Joint Infection remains a clinical challenge with no benchmark for diagnosis. The diagnosis is based on many different clinical variables that may be difficult to interpret, especially in the setting of chronic systemic disease. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of Periprosthetic Joint Infection. As molecular- and biomarker-based technologies improve, the way we interpret and diagnose Periprosthetic Joint Infection will ultimately change and may even improve diagnostic accuracy and turnaround time. Future research on this topic should be focused on improving diagnostic criteria for low-virulence organisms, improving interpretation of intraoperative frozen sections, and establishing improved synovial fluid and peripheral serum biomarker profiles for Periprosthetic Joint Infection.
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The Leukocyte Esterase Test for Periprosthetic Joint Infection Is Not Affected by Prior Antibiotic Administration.
Journal of Bone and Joint Surgery American Volume, 2019Co-Authors: Alisina Shahi, Camilo Restrepo, Elie Ghanem, Abtin Alvand, Javad ParviziAbstract:BACKGROUND: It has been demonstrated that administration of antibiotics prior to performing diagnostic testing for Periprosthetic Joint Infection can interfere with the accuracy of the standard diagnostic tests. Therefore, the purpose of this study was to evaluate the effects of antibiotic administration prior to performing the synovial leukocyte esterase strip test for Periprosthetic Joint Infection. METHODS: We identified 121 patients who underwent revision hip or knee arthroplasty for a Musculoskeletal Infection Society (MSIS)-confirmed Periprosthetic Joint Infection. All patients also had a leukocyte esterase strip test performed. Patients in one group (32%) took antibiotics prior to the diagnostic workup, whereas patients in another group (68%) did not receive antibiotics within 2 weeks of the diagnostic workup. The leukocyte esterase strip test, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), synovial white blood-cell (WBC) count, and polymorphonuclear neutrophil (PMN) percentage were collected and were compared between the 2 groups. RESULTS: The median serum ESR (85 compared with 67 mm/hr for patients who did not and did receive antibiotics; p = 0.009), CRP (16.5 compared with 12.9 mg/L; p = 0.032), synovial WBC count (45,675 compared with 9,650 cells/µL; p < 0.0001), and PMN percentage (93% compared with 88%; p = 0.004) were all significantly lower for patients receiving antibiotics. Furthermore, the administration of antibiotics resulted in a significant decrease in the sensitivity of all tests, except leukocyte esterase: ESR (79.5% in the antibiotics cohort compared with 92.7% in the no-antibiotics cohort [relative risk (RR) for false-negative results, 2.8; p = 0.04]), CRP (64.2% compared with 81.8% [RR, 1.9; p = 0.03]), WBC count (69.3% compared with 93.4% [RR, 5.0; p = 0.001]), PMN percentage (74.4% compared with 91.5% [RR, 3.0; p = 0.01]), and leukocyte esterase (78% compared with 83% [RR, 1.6; p = 0.17]). The rate of negative cultures was higher in the antibiotics group at 30.7% compared with the no-antibiotics group at 12.1% (p = 0.015). CONCLUSIONS: This current study and previous studies have demonstrated that the administration of premature antibiotics can compromise the results of standard diagnostic tests for Periprosthetic Joint Infection, causing significant increases in false-negative results. However, in this study, the leukocyte esterase strip test maintained its performance even in the setting of antibiotic administration. Antibiotic administration prior to diagnostic workups for Periprosthetic Joint Infection stands to interfere with diagnosis. The leukocyte esterase strip test can be used as a reliable diagnostic marker for diagnosing Periprosthetic Joint Infection even when prior antibiotics are administered. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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UTILITY OF NEXT-GENERATION SEQUENCING IN THE DIAGNOSIS OF Periprosthetic Joint Infection
2019Co-Authors: Karan Goswami, Majd Tarabichi, Noam Shohat, Abtin Alvand, Javad ParviziAbstract:Introduction Despite recent advances in the diagnosis of Periprosthetic Joint Infection(PJI), identifying the infecting organism continues to be a challenge, with up to a third of PJIs reported to ...
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in hospital mortality in patients with Periprosthetic Joint Infection
Orthopaedic Proceedings, 2018Co-Authors: Alisina Shahi, Antonia F Chen, Mitchell G. Maltenfort, Javad ParviziAbstract:Periprosthetic Joint Infection (PJI) is one of the most devastating complications of total Joint arthroplasty (TJA). Only a few studies have investigated PJI's impact on the most worrisome of all endpoints, mortality. The purpose of this study was to perform a large-scale study to determine the rates of PJI associated in-hospital mortality, and compare it to other surgical procedures.The Nationwide Inpatient Sample was queried from 2002 to 2010 to assess the risk of mortality for patients undergoing revision for PJI or aseptic failures. Elixhauser comorbidity index and ICD-9 codes were used to obtain patients’ medical conditions and identify PJI. Multiple logistic-regression analyses were used to determine the associated variables with mortality. In-hospital mortality was compared to the followings: coronary-artery bypass graft, mastectomy, prostatectomy, appendectomy, kidney transplant, carotid surgery, cholecystectomy, and coronary interventional procedures.PJI was associated with an increased risk (odd...
Benjamin Zmistowski - One of the best experts on this subject based on the ideXlab platform.
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Exhibit Selection Management of Periprosthetic Joint Infection: The Current Knowledge AAOS Exhibit Selection
2020Co-Authors: Javad Parvizi, Benjamin Zmistowski, Bahar Adeli, Camilo Restrepo, Alan Seth GreenwaldAbstract:Periprosthetic Joint Infection continues to frustrate the medical community. Although the demand for total Joint arthroplasty is increasing, the burden of such Infections is increasing even more rapidly, and they pose a unique challenge because their accurate diagnosis and eradication can prove elusive. This review describes the current knowledge re- garding diagnosis and treatment of Periprosthetic Joint Infection. A number of tools are available to aid in establishing a diagnosis of Periprosthetic Joint Infection. These include the erythrocyte sedimentation rate, serum C-reactive protein concentration, synovial white blood-cell count and differential, imaging studies, tissue specimen culturing, and histo- logical analysis. Multiple definitions of Periprosthetic Joint Infection have been proposed but there is no consensus. Tools under investigation to diagnose such Infections include the C-reactive protein concentration in the Joint fluid, point-of-care strip tests for the leukocyte esterase concentration in the Joint fluid, and other molecular markers of Periprosthetic Joint Infection. Treatment options include irrigation and debridement with prosthesis retention, one-stage prosthesis ex- change, two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer, and salvage treat- ments such as Joint arthrodesis and amputation. Treatment selection is dependent on multiple factors including the timing of the symptom onset, patient health, the infecting organism, and a history of Infection in the Joint. Although prosthesis retention has the theoretical advantages of decreased morbidity and improved return to function, two-stage exchange provides a lower rate of recurrent Infection. As the burden of Periprosthetic Joint Infection increases, the orthopaedic and medical community should become more familiar with the disease. It is hoped that the tools currently under investigation will aid clinicians in diagnosing Periprosthetic Joint Infection in an accurate and timely fashion to allow appropriate treatment. Given the current knowledge and planned future research, the medical community should be prepared to effectively manage this increasingly prevalent disease.
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premature therapeutic antimicrobial treatments can compromise the diagnosis of late Periprosthetic Joint Infection
Clinical Orthopaedics and Related Research, 2015Co-Authors: Alisina Shahi, Benjamin Zmistowski, Camilo Restrepo, Carl Deirmengian, Antonia F Chen, Carlos A Higuera, Javad ParviziAbstract:Background In the absence of positive cultures and draining sinuses, the diagnosis of Periprosthetic Joint Infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI.
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diagnosis of Periprosthetic Joint Infection
Journal of Arthroplasty, 2014Co-Authors: Benjamin Zmistowski, Craig J Della Valle, Thomas W Bauer, Carl Deirmengian, Robert E Booth, Konstantinos N Malizos, Abbas Alavi, Hani Bedair, Peter F M Choong, Garth D EhrlichAbstract:Diagnosis of Periprosthetic Joint Infection (PJI), one of the major causes of failure of total Joint arthroplasty, continues to pose a challenge. One of the major reasons is the lack of a ''gold standard'' to distinguish between septic and aseptic failure. Isolation of an infecting organism in otherwise confirmed PJI also may be challenging as organisms usually reside as a biofilm on the surface of the implant. This limitation can be overcome by using nonculture diagnostic tests, including inflammatory serologies, Joint aspiration with fluid cell count analysis, and tissue biopsy. Imaging tests are limited in their ability to differentiate septic from aseptic Joints and also are limited by cost. While radionuclide imaging modalities have yielded improved results, low accuracy for diagnosis of PJI remains. In recent years there have been some advances in diagnosis of PJI, including creation of evidence based guidelines, creation of a consensus definition of PJI, and emergence of new diagnostic tests and improved understanding of current tests. This review article will highlight some of these advances.
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Periprosthetic Joint Infection increases the risk of one year mortality
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Benjamin Zmistowski, Joseph A Karam, Joel B Durinka, David S Casper, Javad ParviziAbstract:Background: Periprosthetic Joint Infection continues to potentially complicate an otherwise successful Joint replacement. The treatment of this Infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between Periprosthetic Joint Infection and mortality and aimed to determine the effect of Periprosthetic Joint Infection on mortality and any predictors of mortality in patients with Periprosthetic Joint Infection. Methods: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed Periprosthetic Joint Infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety days, one year, two years, and five years after surgery was assessed. Multivariate analysis was used to assess Periprosthetic Joint Infection as an independent predictor of mortality. In the Periprosthetic Joint Infection population, variables investigated as potential risk factors for mortality were evaluated. Results: Mortality was significantly greater (p < 0.001) in patients with Periprosthetic Joint Infection compared with those undergoing aseptic revision arthroplasty at ninety days (3.7% versus 0.8%), one year (10.6% versus 2.0%), two years (13.6% versus 3.9%), and five years (25.9% versus 12.9%). After controlling for age, sex, ethnicity, number of procedures, involvedJoint,bodymassindex,andCharlsonComorbidityIndex,revisionarthroplastyforPeriprostheticJointInfectionwas associated with a fivefold increase in mortality compared with revision arthroplasty for aseptic failures. In the Periprosthetic Joint Infection population, independent predictors of mortality included increasing age, higher Charlson Comorbidity Index, history of stroke, polymicrobial Infections, and cardiac disease. Conclusions: Although it is well known that Periprosthetic Joint Infection is a devastating complication that severely limits Joint function and is consistently difficult to eradicate, surgeons must also be cognizant of the systemic impact of Periprosthetic Joint Infection and its major influence on fatal outcome in patients. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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recurrent Periprosthetic Joint Infection persistent or new Infection
Journal of Arthroplasty, 2013Co-Authors: Benjamin Zmistowski, Craig J Della Valle, Pouya Alijanipour, Antonia F Chen, Matthew W Tetreault, Javad ParviziAbstract:Abstract It is unclear if recurrent Periprosthetic Joint Infection (PJI) is a result of failed pathogen eradication. This study addresses this issue. We identified 92 patients from three institutions who failed two-stage exchange. Cultured organisms at each stage of treatment were compared to determine whether these were persistent or new Infections. Only twenty-nine of the 92 patients (31.5%) had identical organisms at treatment failure. Of the failures associated with Staphylococcus as the original infecting organism, 37% (25 of 67) failed due to the same organism compared to only 16% (four of 25) caused by other organisms. Positive cultures at reimplantation and poor health status were associated with higher rates of recurrent Infection due to new organisms. Successful management of PJI with a two-stage exchange must stress minimization of comorbid risk factors that may contribute to the low success rate of PJI treatment and recurrence of Infection.
Daniel J Berry - One of the best experts on this subject based on the ideXlab platform.
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two stage exchange protocol for Periprosthetic Joint Infection following total knee arthroplasty in 245 knees without prior treatment for Infection
Journal of Bone and Joint Surgery American Volume, 2019Co-Authors: Stephen M Petis, Daniel J Berry, Tad M Mabry, Kevin I Perry, Arlen D Hanssen, Matthew P AbdelAbstract:Background:For patients undergoing 2-stage exchange for the treatment of Periprosthetic Joint Infection (PJI) following total knee arthroplasty, the long-term risk of reInfection and mechanical failure and long-term clinical outcomes are not well known. The purpose of our study was to determine the
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estimating risk in medicare patients with tha an electronic risk calculator for Periprosthetic Joint Infection and mortality
Clinical Orthopaedics and Related Research, 2013Co-Authors: Kevin J Bozic, Steven M Kurtz, Thomas P Vail, Daniel J Berry, Harry E RubashAbstract:Background Although risk factors for Periprosthetic Joint Infection (PJI) and mortality after total hip arthroplasty (THA) have been identified, interactions between specific patient risk factors are poorly understood. Therefore, it is difficult for surgeons to counsel patients on their individual risk of PJI or mortality after THA.
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patient related risk factors for Periprosthetic Joint Infection and postoperative mortality following total hip arthroplasty in medicare patients
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Kevin J Bozic, Steven M Kurtz, Harry E Rubash, Thomas P Vail, Daniel J BerryAbstract:Background: The patient-related risk factors for Periprosthetic Joint Infection and postoperative mortality in elderly patients undergoing total hip arthroplasty are poorly understood. The purpose of this study was to identify the specific patient comorbidities that are associated with an increased risk of Periprosthetic Joint Infection and of ninety-day postoperative mortality in U.S. Medicare patients undergoing total hip arthroplasty. Methods: The Medicare 5% sample claims database was used to calculate the relative risk of Periprosthetic Joint Infection and of ninety-day postoperative mortality as a function of preexisting comorbidities in 40,919 patients who underwent primary total hip arthroplasty between 1998 and 2007. The impact of twenty-nine comorbid conditions on Periprosthetic Joint Infection and on postoperative mortality was examined with use of Cox regression, controlling for age, sex, census region, public assistance, and all other baseline comorbidities. The adjusted hazard ratios for all comorbid conditions were evaluated, and the Wald chi-square statistic was used to rank the degree of association of each condition with Periprosthetic Joint Infection and with postoperative mortality. The Bonferroni-Holm method was used to adjust for the multiple comparisons resulting from the number of comorbid conditions analyzed. Results: Comorbid conditions associated with an increased adjusted risk of Periprosthetic Joint Infection (in decreasing order of significance, p < 0.05 for all comparisons) were rheumatologic disease (hazard ratio [HR] = 1.71), obesity (HR = 1.73), coagulopathy (HR = 1.58), and preoperative anemia (HR = 1.36). Comorbid conditions associated with an increased adjusted risk of ninety-day postoperative mortality (in decreasing order of significance, p < 0.05 for all comparisons) were congestive heart failure (HR = 2.11), metastatic cancer (HR = 3.14), psychosis (HR = 1.85), renal disease (HR = 1.98), dementia (HR = 2.04), hemiplegia or paraplegia (HR = 2.62), cerebrovascular disease (HR = 1.40), and chronic pulmonary disease (HR = 1.32). Conclusions: We identified specific patient comorbidities that were independently associated with an increased risk of Periprosthetic Joint Infection and of ninety-day postoperative mortality in Medicare patients who had undergone total hip arthroplasty. This information is important when counseling elderly patients regarding the risks of Periprosthetic Joint Infection and mortality following total hip arthroplasty, as well as for risk adjustment of publicly reported total hip arthroplasty outcomes. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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patient related risk factors for postoperative mortality and Periprosthetic Joint Infection in medicare patients undergoing tka
Clinical Orthopaedics and Related Research, 2012Co-Authors: Kevin J Bozic, Steven M Kurtz, Daniel J BerryAbstract:Background The impact of specific baseline comorbid conditions on the relative risk of postoperative mortality and Periprosthetic Joint Infection (PJI) in elderly patients undergoing TKA has not been well defined.
Craig J Della Valle - One of the best experts on this subject based on the ideXlab platform.
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Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection
Journal of Arthroplasty, 2016Co-Authors: Eric H. Tischler, Antonia F Chen, Craig J Della Valle, Darren R. Plummer, Javad ParviziAbstract:Abstract Background Adverse local tissue reactions (ALTRs) and Periprosthetic Joint Infection can occur after metal-on-metal total hip arthroplasty (THA), both potentially generating purulent synovial fluid (SF) and elevated white cell count. This makes it difficult to distinguish between diagnoses; therefore, we evaluated leukocyte esterase (LE) strip test's reliability in ruling out Periprosthetic Joint Infection in ALTR revision THA. Methods Sixty-one patients with ALTRs and an LE strip test were evaluated, excluding 15 cases with SF metallic debris. LE strip tests were classified −/trace, + (mildly positive), and ++ (strongly positive). Results LE strip tests were ++, +, −/trace in 8 patients (13.1%), 14 (23.0%), and 39 (63.9%), respectively. Means and ranges of SF white cell count and polymorphonuclear percentage were 1291.4 (0-10,886 cells/μL), and 46.1% (0%-94%), respectively. Conclusion ++ LE strip test, in conjunction with preoperative work-ups, reliably rules out Infection in 92.9% of patients undergoing THA revision secondary to ALTR.
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is synovial c reactive protein a useful marker for Periprosthetic Joint Infection
Clinical Orthopaedics and Related Research, 2014Co-Authors: Matthew W Tetreault, Nathan G Wetters, Mario Moric, Christopher E Gross, Craig J Della ValleAbstract:Background Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing Periprosthetic Joint Infection (PJI).
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culture negative Periprosthetic Joint Infection
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Javad Parvizi, Omer Faruk Erkocak, Craig J Della ValleAbstract:➤ Negative results on culture still pose a real challenge in the diagnosis of Periprosthetic Joint Infection. ➤ There are numerous reasons for the inability to isolate the infecting organism from the affected Joint, the most important of which is the administration of antibiotics prior to obtaining culture samples. ➤ For patients suspected of having a Periprosthetic Joint Infection, antibiotics should not be given until the diagnosis is confirmed or aspiration of the Joint should be delayed for at least two weeks after the last dose of antibiotics. ➤ Other strategies that can be used to enhance the likelihood of obtaining a positive result on culture include expeditious transport of culture samples, placement of a tissue or fluid sample in the appropriate medium, implant sonication, and prolonging the incubation period of the samples to two or three weeks. ➤ In patients in whom the prerevision aspiration has not yielded an infecting organism, yet the clinical picture is consistent with Periprosthetic Joint Infection, a minimum of three to five tissue culture samples are recommended at the time of revision surgery. ➤ Biomarkers and molecular techniques, such as polymerase chain reaction identification of bacterial DNA, may play an increasing role in the future in the diagnosis of Periprosthetic Joint Infection, when standardized techniques have not identified an infecting organism.
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diagnosis of Periprosthetic Joint Infection
Journal of Arthroplasty, 2014Co-Authors: Benjamin Zmistowski, Craig J Della Valle, Thomas W Bauer, Carl Deirmengian, Robert E Booth, Konstantinos N Malizos, Abbas Alavi, Hani Bedair, Peter F M Choong, Garth D EhrlichAbstract:Diagnosis of Periprosthetic Joint Infection (PJI), one of the major causes of failure of total Joint arthroplasty, continues to pose a challenge. One of the major reasons is the lack of a ''gold standard'' to distinguish between septic and aseptic failure. Isolation of an infecting organism in otherwise confirmed PJI also may be challenging as organisms usually reside as a biofilm on the surface of the implant. This limitation can be overcome by using nonculture diagnostic tests, including inflammatory serologies, Joint aspiration with fluid cell count analysis, and tissue biopsy. Imaging tests are limited in their ability to differentiate septic from aseptic Joints and also are limited by cost. While radionuclide imaging modalities have yielded improved results, low accuracy for diagnosis of PJI remains. In recent years there have been some advances in diagnosis of PJI, including creation of evidence based guidelines, creation of a consensus definition of PJI, and emergence of new diagnostic tests and improved understanding of current tests. This review article will highlight some of these advances.
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recurrent Periprosthetic Joint Infection persistent or new Infection
Journal of Arthroplasty, 2013Co-Authors: Benjamin Zmistowski, Craig J Della Valle, Pouya Alijanipour, Antonia F Chen, Matthew W Tetreault, Javad ParviziAbstract:Abstract It is unclear if recurrent Periprosthetic Joint Infection (PJI) is a result of failed pathogen eradication. This study addresses this issue. We identified 92 patients from three institutions who failed two-stage exchange. Cultured organisms at each stage of treatment were compared to determine whether these were persistent or new Infections. Only twenty-nine of the 92 patients (31.5%) had identical organisms at treatment failure. Of the failures associated with Staphylococcus as the original infecting organism, 37% (25 of 67) failed due to the same organism compared to only 16% (four of 25) caused by other organisms. Positive cultures at reimplantation and poor health status were associated with higher rates of recurrent Infection due to new organisms. Successful management of PJI with a two-stage exchange must stress minimization of comorbid risk factors that may contribute to the low success rate of PJI treatment and recurrence of Infection.
Steven M Kurtz - One of the best experts on this subject based on the ideXlab platform.
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estimating risk in medicare patients with tha an electronic risk calculator for Periprosthetic Joint Infection and mortality
Clinical Orthopaedics and Related Research, 2013Co-Authors: Kevin J Bozic, Steven M Kurtz, Thomas P Vail, Daniel J Berry, Harry E RubashAbstract:Background Although risk factors for Periprosthetic Joint Infection (PJI) and mortality after total hip arthroplasty (THA) have been identified, interactions between specific patient risk factors are poorly understood. Therefore, it is difficult for surgeons to counsel patients on their individual risk of PJI or mortality after THA.
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economic burden of Periprosthetic Joint Infection in the united states
Journal of Arthroplasty, 2012Co-Authors: Heather N Watson, Steven M Kurtz, Jordana K Schmier, Javad ParviziAbstract:This study characterizes the patient and clinical factors influencing the economic burden of Periprosthetic Joint Infection (PJI) in the United States. The 2001-2009 Nationwide Inpatient Sample was used to identify total hip and knee arthroplasties using International Classification of Diseases, Ninth Revision, procedure codes. The relative incidence of PJI ranged between 2.0% and 2.4% of total hip arthroplasties and total knee arthroplasties and increased over time. The mean cost to treat hip PJIs was $5965 greater than the mean cost for knee PJIs. The annual cost of infected revisions to US hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. As the demand for Joint arthroplasty is expected to increase substantially over the coming decade, so too will the economic burden of prosthetic Infections.
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patient related risk factors for Periprosthetic Joint Infection and postoperative mortality following total hip arthroplasty in medicare patients
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Kevin J Bozic, Steven M Kurtz, Harry E Rubash, Thomas P Vail, Daniel J BerryAbstract:Background: The patient-related risk factors for Periprosthetic Joint Infection and postoperative mortality in elderly patients undergoing total hip arthroplasty are poorly understood. The purpose of this study was to identify the specific patient comorbidities that are associated with an increased risk of Periprosthetic Joint Infection and of ninety-day postoperative mortality in U.S. Medicare patients undergoing total hip arthroplasty. Methods: The Medicare 5% sample claims database was used to calculate the relative risk of Periprosthetic Joint Infection and of ninety-day postoperative mortality as a function of preexisting comorbidities in 40,919 patients who underwent primary total hip arthroplasty between 1998 and 2007. The impact of twenty-nine comorbid conditions on Periprosthetic Joint Infection and on postoperative mortality was examined with use of Cox regression, controlling for age, sex, census region, public assistance, and all other baseline comorbidities. The adjusted hazard ratios for all comorbid conditions were evaluated, and the Wald chi-square statistic was used to rank the degree of association of each condition with Periprosthetic Joint Infection and with postoperative mortality. The Bonferroni-Holm method was used to adjust for the multiple comparisons resulting from the number of comorbid conditions analyzed. Results: Comorbid conditions associated with an increased adjusted risk of Periprosthetic Joint Infection (in decreasing order of significance, p < 0.05 for all comparisons) were rheumatologic disease (hazard ratio [HR] = 1.71), obesity (HR = 1.73), coagulopathy (HR = 1.58), and preoperative anemia (HR = 1.36). Comorbid conditions associated with an increased adjusted risk of ninety-day postoperative mortality (in decreasing order of significance, p < 0.05 for all comparisons) were congestive heart failure (HR = 2.11), metastatic cancer (HR = 3.14), psychosis (HR = 1.85), renal disease (HR = 1.98), dementia (HR = 2.04), hemiplegia or paraplegia (HR = 2.62), cerebrovascular disease (HR = 1.40), and chronic pulmonary disease (HR = 1.32). Conclusions: We identified specific patient comorbidities that were independently associated with an increased risk of Periprosthetic Joint Infection and of ninety-day postoperative mortality in Medicare patients who had undergone total hip arthroplasty. This information is important when counseling elderly patients regarding the risks of Periprosthetic Joint Infection and mortality following total hip arthroplasty, as well as for risk adjustment of publicly reported total hip arthroplasty outcomes. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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patient related risk factors for postoperative mortality and Periprosthetic Joint Infection in medicare patients undergoing tka
Clinical Orthopaedics and Related Research, 2012Co-Authors: Kevin J Bozic, Steven M Kurtz, Daniel J BerryAbstract:Background The impact of specific baseline comorbid conditions on the relative risk of postoperative mortality and Periprosthetic Joint Infection (PJI) in elderly patients undergoing TKA has not been well defined.
