Risk factors for prosthetic joint infections following total hip arthroplasty based on the Finnish Arthroplasty Register

Abstract

Background Periprosthetic joint infection (PJI) is a devastating complication which leads to reduced physical functioning, pain, poor quality of life, and even death of the patient. The aim of this study was to assess risk factors for PJI after primary total hip arthroplasty (THA) based on the Finnish Arthroplasty Register (FAR).

Methods We analyzed 33,337 primary THAs performed between May 2014 and January 2018. Cox proportional hazards regression was used to estimate hazard ratios with 95% confidence intervals for first PJI revision operation using 25 potential patient and surgical related risk factors as covariates.

Results 350 primary THAs were revised first time due to PJI during the study period. The hazard ratios for PJI revision was 0.6 (95% CI 0.4–0.8) for females compared to males, 0.4 (95% CI 0.2–0.7) for ceramic-on-ceramic bearing surface compared to metal-on-UHXLPE, 2.4 (95% CI 1.5–3.7) for BMI of 30–35 and 4.7 (95% CI 2.9–7.6) for BMI >35 compared to patients with BMI of < 25, 2.2 (95% CI 1.3–3.7) for operation time of 90–120 min and 2.8 (95% CI 1.5–5.3) for operation time of >120 min compared to operation time of 45–59 min, and 2.2 (95% CI 1.2–3.9) for the use of epidural anesthesia.

Conclusions We found several modifiable risk factors associated with increased PJI revision risk after THA. Especially high BMI may be even more prominent risk factor than assessed previously and should be paid special attention to preoperatively.