Patients who are under 60 years of age, males, those with chronic pulmonary disease, diabetes, and a higher body mass index are at increased risk of needing revision surgery after a joint replacement due to infection, researchers note.

Some patients are at risk of early infection, while others are more prone to late infection after hip replacement, according to the researchers, from the Musculoskeletal Research Unit at the University of Bristol.

Published in The Lancet Infectious Diseases and funded by the National Institute for Health Research (NIHR), the study considered the risk of infection following first-time (primary) hip replacement. This study used data from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man linked to the Hospital Episode Statistics database. In total it analyzed data  from more than 600,000 primary hip replacement patients, of whom 2,705 underwent revision for infection, according to a media release from the University of Bristol.

The surgical approach used by the surgeon and the implant materials influenced the risk of needing revision surgery for infection, according to the study. Hip replacements performed via a posterior surgical approach and those that used implant bearings that contained ceramic were less likely to be revised for an infection.

Hip replacements performed for a hip fracture were at higher risk of infection. Interestingly, the experience of the surgeon and the size of the orthopaedic center had no or only small effects on risk of revision for infection.

These factors have a different effect according to the postoperative period considered, with co-morbidities such as dementia influencing early revision for prosthetic joint infection and liver diseases influencing long-term revision, the release explains.

“We have shown that certain types of patients, such as those with liver disease, are at particular risk of long-term infection and they would benefit from extra surveillance and tailored information following their discharge from hospital to reduce this risk,” says Dr Erik Lenguerrand, Research Fellow in the Musculoskeletal Research Unit and the study’s lead author, in the release.

The risk of revision for infection following primary hip replacement is mainly driven by patient and surgical factors. The potentially modifiable factors identified in this study should be considered by clinicians when preparing patients for hip replacement surgery, the release cautions.

It will be important to carry out research to establish if changes to the management of these conditions changes the risk of infection. It is equally important for clinicians to consider the factors that can’t be changed and the factors that exhibit time specific effects on the risk of prosthetic joint infection, to support and inform patients appropriately preoperatively.

The research team will carry out further work to determine if similar patterns and risk factors are also seen for knee replacement. Finally, the researchers will also be looking at the treatment of infection when it does occur to see what treatment results in the best outcomes for patients. They will analyze further data from the National Joint Registry and are currently conducting a large multinational randomized controlled trial to generate the best evidence possible in this area, the release concludes.

[Source(s): University of Bristol, EurekAlert]