Limiting the Surveillance Period to 90 Days Misses a Large Portion of Infections in the First Year After Total Hip and Knee Arthroplasty

Stefano Muscatelli, Huiyong Zheng, Aditya Muralidharan, Viktor Tollemar, Brian R Hallstrom, Stefano Muscatelli, Huiyong Zheng, Aditya Muralidharan, Viktor Tollemar, Brian R Hallstrom

Abstract

Background: In 2013, the Centers for Disease Control and Prevention reduced the periprosthetic joint infection (PJI) surveillance period from 1 year to 90 days for total hip (THA) and knee arthroplasty (TKA). Our aim was to determine how the reduced surveillance window impacts capture of PJIs.

Material and methods: Primary and revision THA and TKA cases were retrospectively identified in a statewide registry from October 1, 2015, to September 30, 2018. Infections were defined using the Periprosthetic Joint/Wound Infection measure (Centers for Medicare and Medicaid Services). We compared the cumulative incidence of infected primary and revision THA (pTHA/rTHA) and TKA (pTKA/rTKA) at 0-90 days and 91-365 days postoperatively.

Results: A total of 136,491 patients were included, 59.59% female, mean age 65.8 years, and mean body mass index 32.3 kg/m2. The overall rate of PJI diagnosed by 1 year was 1.33%. The percent of infections diagnosed between 0-90 days and 91-365 days were pTHA 76.78% and 23.22%, rTHA 74.12% and 25.88%, pTKA 57.67% and 42.33%, and rTKA 53.78% and 46.22%, respectively. More infections were diagnosed after 90 days in pTKA than in pTHA and in rTKA than in rTHA (P < .0001). There was a higher risk of infection throughout the year when comparing rTKA to rTHA (P = .0374) but not when comparing pTKA to pTHA (P = .0518).

Conclusion: A substantial portion of infections are missed by the 90-day surveillance period. More infections are missed after TKA than after THA. Extension of the surveillance period would allow for identification of opportunities for quality improvement.

Keywords: Infection; Quality improvement; Total hip arthroplasty; Total knee arthroplasty.

© 2022 The Authors.

Figures

Figure 1
Figure 1
Flow chart of cases included for analysis. ASC, Ambulatory Surgery Center.
Figure 2
Figure 2
Percent of infections captured from 0 to 90 days and from 91 to 365 days for primary TKA, primary THA, revision TKA, and revision THA; ∗infections diagnosed 91-365 days, primary TKA > primary THA (P < .0001); ∗∗ infections diagnosed 91-365 days, revision TKA > revision THA (P < .0001).
Figure 3
Figure 3
Cumulative percent infection with 95% confidence interval within 1 year for primary TKA and THA for all 3 periods combined. The risk of infection throughout the year was not statistically different for primary TKA vs THA (log rank P value = .0518). Y-axis matched with Figure 4 for visual comparison.
Figure 4
Figure 4
Cumulative percent infection with 95% confidence interval within 1 year for revision TKA and THA for all 3 periods combined. The risk of infection throughout the year was greater for revision TKA vs THA (log rank P value = .0374). Y-axis matched with Figure 3 for visual comparison.

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