title: A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection.
abstract: BACKGROUND
  After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site.
  
  
  OBJECTIVE
  The primary objective of this study is to determine if there is a difference in the risk of developing a PJI after a second total hip arthroplasty (THA) or total knee arthroplasty (TKA) in patients who have had a previous PJI at another anatomic site compared with patients who have had no history of PJI. The secondary objective is to determine other potential risk factors that may predict PJI at the site of the second arthroplasty.
  
  
  METHODS
  A retrospective matched cohort study was performed to identify all patients at four academic institutions successfully treated for PJI who subsequently underwent a second primary THA or TKA (n = 90), constituting our study group. Patients were matched (one-to-one) to control subjects who had no history of PJI after their first arthroplasty (n = 90); they were matched based on age, sex, diabetic status, BMI, American Society of Anesthesiologists, institution, joint of interest, and year of surgery (± 2 years). We compared the case and control groups to determine whether a prior infection increased the relative risk of a subsequent PJI at another anatomic site. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) was performed. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) was performed.
  
  
  RESULTS
  Patients with a history of PJI had a greater risk of developing PJI in a subsequent THA or TKA (10 of 90 versus zero of 90 in the control group; relative risk, 21.00; 95% confidence interval [CI], 1.25-353.08; p = 0.035). Excluding PJI, we identified no other factors associated with a second joint infection. In patients with a history of PJI, a second PJI occurred more frequently in female patients (female: nine of 10 [90%] versus female: 40 of 80 [50%]; odds ratio [OR], 8.83; 95% CI, 1.13-403.33; p = 0.02) and in those whose initial infection was a staphylococcal species (subsequent PJI seven of 10 [70%] versus no subsequent PJI 28 of 80 [35%]; OR, 4.26; 95% CI, 0.89-27.50; p = 0.04).
  
  
  CONCLUSIONS
  A history of PJI predisposes patients to subsequent PJI in primary THA or THA. Patients and surgeons must be aware of the higher risk of this devastating complication before proceeding with a second arthroplasty.
  
  
  METHODS
  Level III, prognostic study.
authors: Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA.
authors: Hany
authors: H
authors: Bedair
authors: Nitin
authors: N
authors: Goyal
authors: Mathew J
authors: MJ
authors: Dietz
authors: Kenneth
authors: K
authors: Urish
authors: Viktor
authors: V
authors: Hansen
authors: Jorge
authors: J
authors: Manrique
authors: William
authors: W
authors: Hamilton
authors: Greg
authors: G
authors: Deirmengian
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015331:Cohort Studies; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment