The "true" incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties: a prospective cohort study

Per Hviid Gundtoft, Søren Overgaard, Henrik Carl Schønheyder, Jens Kjølseth Møller, Per Kjærsgaard-Andersen, Alma Becic Pedersen, Per Hviid Gundtoft, Søren Overgaard, Henrik Carl Schønheyder, Jens Kjølseth Møller, Per Kjærsgaard-Andersen, Alma Becic Pedersen

Abstract

Background and purpose: It has been suggested that the risk of prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA) may be underestimated if based only on arthroplasty registry data. We therefore wanted to estimate the "true" incidence of PJI in THA using several data sources.

Patients and methods: We searched the Danish Hip Arthroplasty Register (DHR) for primary THAs performed between 2005 and 2011. Using the DHR and the Danish National Register of Patients (NRP), we identified first revisions for any reason and those that were due to PJI. PJIs were also identified using an algorithm incorporating data from microbiological, prescription, and clinical biochemistry databases and clinical findings from the medical records. We calculated cumulative incidence with 95% confidence interval.

Results: 32,896 primary THAs were identified. Of these, 1,546 had first-time revisions reported to the DHR and/or the NRP. For the DHR only, the 1- and 5-year cumulative incidences of PJI were 0.51% (0.44-0.59) and 0.64% (0.51-0.79). For the NRP only, the 1- and 5-year cumulative incidences of PJI were 0.48% (0.41-0.56) and 0.57% (0.45-0.71). The corresponding 1- and 5-year cumulative incidences estimated with the algorithm were 0.86% (0.77-0.97) and 1.03% (0.87-1.22). The incidences of PJI based on the DHR and the NRP were consistently 40% lower than those estimated using the algorithm covering several data sources.

Interpretation: Using several available data sources, the "true" incidence of PJI following primary THA was estimated to be approximately 40% higher than previously reported by national registries alone.

Figures

Figure 1.
Figure 1.
Revisions identified in either the DHR or the NRP.
Figure 2.
Figure 2.
Algorithm for classification of the1,522 first-time revisions performed because of deep infection or other causes.
Figure 3.
Figure 3.
Algorithm (continued) for classification of the revisions performed due to periprosthetic joint infection or other causes.
Figure 4.
Figure 4.
Prosthetic joint infections over 1 year, with 95% CI.

References

    1. Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH. . Dan Med Bull. 1999;46(3):263–8.
    1. Arthursson AJ, Furnes O, Espehaug B, Havelin LI, Soreide JA. . Acta Orthop. 2005;76(6):823–8.
    1. Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR. . J Clin Microbiol. 1998;36(10):2932–9.
    1. Bauer TW, Parvizi J, Kobayashi N, Krebs V. . J Bone Joint Surg Am. 2006;88(4):869–82.
    1. Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, Denormandie P, Arvieux C, Chirouze C, Perronne C, Hoffmeyer P. . Scand J Infect Dis. 2004;36(6)(7):410–6.
    1. Biant LC, Bruce WJ, van der Wall H, Walsh WR. . J Arthroplasty. 2010;25(2):334. e11-6.
    1. Blumenfeld TJ, Bargar WL, Campbell PA. . J Arthroplasty. 2010;25(7):1168.
    1. Bozic KJ, Ries MD. . J Bone Joint Surg Am. 2005;87(8):1746–51.
    1. Dale H, Skramm I, Lower HL, Eriksen HM, Espehaug B, Furnes O, Skjeldestad FE, Havelin LI, Engesaeter LB. . Acta Orthop. 2011;82(6):646–54.
    1. Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S, Pedersen AB, Karrholm J, Garellick G, Pulkkinen P, Eskelinen A, Makela K, Engesaeter LB. . Acta Orthop. 2012;83(5):449–58.
    1. Danish Hip Arthroplasty Register Annual report 2012. Annual report 2012. 20122014
    1. Della Valle C, Parvizi J, Bauer TW, Dicesare PE, Evans RP, Segreti J, Spangehl M, Watters WC, 3rd, Keith M, Turkelson CM, Wies JL, Sluka P, Hitchcock K. . J Am Acad Orthop Surg. 2010;18(12):760–70.
    1. Espehaug B, Furnes O, Havelin LI, Engesaeter LB, Vollset SE, Kindseth O. . Acta Orthop. 2006;77(1):49–56.
    1. Grann AF, Erichsen R, Nielsen AG, Froslev T, Thomsen RW. Existing data sources for clinical epidemiology: The clinical laboratory information system (LABKA) research database at Aarhus University. Denmark. Clin Epidemiol. 2011;3:133–8.
    1. Huotari K, Lyytikainen O, Ollgren J, Virtanen MJ, Seitsalo S, Palonen R, Rantanen P. . J Hosp Infect. 2010;75(3):205–8.
    1. Jamsen E, Huotari K, Huhtala H, Nevalainen J, Konttinen YT. . Acta Orthop. 2009;80(2):205–12.
    1. Johannesdottir SA, Horvath-Puho E, Ehrenstein V, Schmidt M, Pedersen L, Sorensen HT. . Clin Epidemiol. 2012;4:303–13.
    1. Kamme C, Lindberg L. . Clinical Orthopaedics and Related Research. 1981;154:201–7.
    1. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. . J Arthroplasty. 2008;23(7):984–91.
    1. Lachiewicz PF, Rogers GD, Thomason HC. . J Bone Joint Surg Am. 1996;78(5):749–54.
    1. Lorentzen JE, Sørensen TS. Proteseinfektioner I Kar- Og Ortopædkirurgi. Mohns Bogtrykkeri. Copenhagen. 1986.
    1. Malekzadeh D, Osmon DR, Lahr BD, Hanssen AD, Berbari EF. . Clin Orthop Relat Res. 2010;468(8):2039–45.
    1. Malhotra R, Morgan DA. . J Arthroplasty. 2004;19(1):78–87.
    1. Mikkelsen DB, Pedersen C, Hojbjerg T, Schonheyder HC. . Apmis. 2006;114(6):449–52.
    1. Molvik H, Hanna SA, de Roeck NJ. . Am J Orthop (Belle Mead NJ) 2010;39(5):E46–9.
    1. Nordic Centre for Classifications in Health Care NOMESCO Classification of Surgical Procedures (NCSP), version 1.14. AN:sats - Tryk & Design a-s,, Copenhagen. 2008.
    1. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. . J Arthroplasty. 2009;24(6 Suppl):105–9.
    1. Parvizi J, Gehrke T. Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection; Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection; 2013.
    1. Parvizi J, Jacovides C, Zmistowski B, Jung KA. . Clin Orthop Relat Res. 2011a;469(11):3022–30.
    1. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. . Clin Orthop Relat Res. 2011b;469(11):2992–4.
    1. Pedersen A, Johnsen S, Overgaard S, Soballe K, Sorensen HT, Lucht U. . Acta Orthop Scand. 2004;75(4):434–41.
    1. Pedersen CB. . Scand J Public Health. 2011;39(7 Suppl):22–5.
    1. Ranstam J, Karrholm J, Pulkkinen P, Makela K, Espehaug B, Pedersen AB, Mehnert F, Furnes O. Statistical analysis of arthroplasty data. II. Guidelines. Acta Orthop. 2011;82(3):258–67.
    1. Savarino L, Baldini N, Tarabusi C, Pellacani A, Giunti A. . J Biomed Mater Res B Appl Biomater. 2004;70(1):139–45.
    1. Schafer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. . Clin Infect Dis. 2008;47(11):1403–9.
    1. Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. . J Bone Joint Surg Am. 2008;90(9):1869–75.
    1. Soderman P, Malchau H, Herberts P, Johnell O. . J Arthroplasty. 2000;15(7):884–9.
    1. Statistic Denmark
    1. Swedish Hip Arthroplasty Register Annual report 2011 page 56-58. Annual report 2011 page 56-58. 2012.
    1. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. . N Engl J Med. 2007;357(7):654–63.
    1. Williams JL, Norman P, Stockley I. . J Arthroplasty. 2004;19(5):582–6.
    1. Yi PH, Cross MB, Moric M, Sporer SM, Berger RA, Della Valle CJ. . Clin Orthop Relat Res. 2014;472(2):424–9.
    1. Zimmerli W, Trampuz A, Ochsner PE. . N Engl J Med. 2004;351(16):1645–54.

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