title: Periprosthetic joint infection increases the risk of one-year mortality.
abstract: BACKGROUND
  Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.
  
  
  METHODS
  Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety days, one year, two years, and five years after surgery was assessed. Multivariate analysis was used to assess periprosthetic joint infection as an independent predictor of mortality. In the periprosthetic joint infection population, variables investigated as potential risk factors for mortality were evaluated.
  
  
  RESULTS
  Mortality was significantly greater (p < 0.001) in patients with periprosthetic joint infection compared with those undergoing aseptic revision arthroplasty at ninety days (3.7% versus 0.8%), one year (10.6% versus 2.0%), two years (13.6% versus 3.9%), and five years (25.9% versus 12.9%). After controlling for age, sex, ethnicity, number of procedures, involved joint, body mass index, and Charlson Comorbidity Index, revision arthroplasty for periprosthetic joint infection was associated with a fivefold increase in mortality compared with revision arthroplasty for aseptic failures. In the periprosthetic joint infection population, independent predictors of mortality included increasing age, higher Charlson Comorbidity Index, history of stroke, polymicrobial infections, and cardiac disease.
  
  
  CONCLUSIONS
  Although it is well known that periprosthetic joint infection is a devastating complication that severely limits joint function and is consistently difficult to eradicate, surgeons must also be cognizant of the systemic impact of periprosthetic joint infection and its major influence on fatal outcome in patients.
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: research@rothmaninstitute.net.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zmistowski
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: research@rothmaninstitute.net.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Karam
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: research@rothmaninstitute.net.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Durinka
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: research@rothmaninstitute.net.
authors.forename: David S
authors.initials: DS
authors.lastname: Casper
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi: research@rothmaninstitute.net.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome