title: Incidence, secular trends, and outcomes of prosthetic joint infection: a population-based study, olmsted county, Minnesota, 1969-2007.
abstract: BACKGROUND
  The epidemiology of prosthetic joint infection (PJI) in a population-based cohort has not been studied in the United States.
  
  
  OBJECTIVE
  To provide an accurate assessment of the true incidence, secular trends, clinical manifestations, microbiology, and treatment outcomes of PJI in a population-based cohort.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Olmsted County, Minnesota.
  
  
  METHODS
  Residents who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) between January 1, 1969, and December 31, 2007.
  
  
  METHODS
  Incidence rates and trends in PJI were assessed using the Kaplan-Meier method and log-rank test, as were treatment outcomes among PJI case patients.
  
  
  RESULTS
  A total of 7,375 THAs or TKAs were implanted in residents of Olmsted County during the study period. Seventy-five discrete joints in 70 individuals developed PJI, during a mean ± SD follow-up of [Formula: see text] years. The cumulative incidence of PJI was 0.5%, 0.8%, and 1.4% after 1, 5, and 10 years after arthroplasty, respectively. Overall, the rate of survival free of clinical failure after treatment of PJI was 76.8% (95% confidence interval [CI], 64.3-85.2) and 65.2% (95% CI, 33.1-76.2) at 3 and 5 years, respectively. The incidence and treatment outcomes did not significantly differ by decade of implantation, patient age at implantation, gender, or joint location.
  
  
  CONCLUSIONS
  The incidence of PJI is relatively low in a population-based cohort and is a function of age of the prosthesis. Incidence trends and outcomes have not significantly changed over the past 40 years.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. gtsaras@uic.edu
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tsaras
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Osmon
authors.forename: Tad
authors.initials: T
authors.lastname: Mabry
authors.forename: Brian
authors.initials: B
authors.lastname: Lahr
authors.forename: Jennifer
authors.initials: J
authors.lastname: St Sauveur
authors.forename: Barbara
authors.initials: B
authors.lastname: Yawn
authors.forename: Robert
authors.initials: R
authors.lastname: Kurland
authors.forename: Elie F
authors.initials: EF
authors.lastname: Berbari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011475:Prosthesis Failure / Q000639:trends*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus; D057787:Staphylococcus lugdunensis; D013290:Streptococcal Infections / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents