Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2022; 13(10): 903-910
Published online Oct 18, 2022. doi: 10.5312/wjo.v13.i10.903
Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty: A 1-year experience
Giuseppe Ferdinando Tella, Cesare Donadono, Francesco Castagnini, Barbara Bordini, Monica Cosentino, Michele Di Liddo, Francesco Traina
Giuseppe Ferdinando Tella, Cesare Donadono, Francesco Castagnini, Michele Di Liddo, Francesco Traina, Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
Barbara Bordini, Monica Cosentino, Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
Author contributions: Tella GF, Donadono C, Castagnini F, Bordini B, Cosentino M, Di Liddo M, and Traina F contributed equally to all aspects of this work.
Institutional review board statement: The study was reviewed and approved by the Comitato Etico di Area Vasta Emilia Centro della Regione Emilia-Romagna (CE-AVEC), Approval No. 0005172.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at c.donadono@gmail.com. Consent was not supposed to be obtained because of the characteristics of the study and the impossibility to contact the patient but by the way the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cesare Donadono, MD, Doctor, Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, Bologna 40125, Italy. c.donadono@gmail.com
Received: December 24, 2021
Peer-review started: December 24, 2021
First decision: February 15, 2022
Revised: February 27, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: October 18, 2022
Processing time: 296 Days and 18.3 Hours
Abstract
BACKGROUND

Periprosthetic joint infection (PJI) in primary total hip replacement (THR) is one of the most important threats in orthopedic surgery, so one important surgeon’s target is to avoid or early diagnose a PJI. Although the incidence of PJI is very low (0.69%) in our department, with an average follow-up of 595 d, this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.

AIM

To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.

METHODS

We counted 583 THR for 578 patients and observed only 4 cases of infection (0.69%) with a mean follow-up of 596 d (min 30, max 1451). We reviewed all medical records to collect the data: duration and time of the surgery, presence, type and duration of the antibiotic therapy, preoperative diagnosis, blood values before and after surgery, transfusions, presence of preoperative drugs (in particularly anticoagulants and antiaggregant, corticosteroids and immunosuppressants), presence of some comorbidities (high body mass index, blood hypertension, chronic obstructive pulmonary disease, cardiac ischemia, diabetes, rheumatological conditions, previous local infections).

RESULTS

No preoperative, intraoperative, or postoperative analysis showed a higher incidence of PJI. We did not find any class with evident major odds of PJI. In our study, we did not find any border value to predict PJI and all patients had similar values in both groups (non-PJI and PJI). Only some categories, such as female patients, showed more frequency of PJI, but this difference related to sex was not statistically significant.

CONCLUSION

We did not find any category with a higher risk of PJI in THR, probably due to the lack of few cases of infection.

Keywords: Primary total hip replacement; Periprosthetic joint infection; Preoperative risk factors; Postoperative risk factors; Preoperative and postoperative blood value; Total hip arthroplasty

Core Tip: In this study, we evaluated the incidence of periprosthetic joint infection in all interventions occurring in the year 2016 at our department at IRCCS Istituto Ortopedico Rizzoli. We reviewed all operated patients to look for predictive signs of potential infection to explore methodological approaches that could better inform daily orthopedic practice. We reviewed the duration and time of surgery, presence, type and duration of antibiotic therapy, preoperative diagnosis, some blood values before and after surgery, transfusions, the presence of preoperative drugs, and the presence of some comorbidities.