Epidemiology of Total Hip and Knee Arthroplasty Infection

Abstract

Prosthetic joint infection (PJI) is an infrequent complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA) but is associated with longer hospital stay, increased hospital cost, and higher morbidity. This chapter critically reviews the literature to form a consensus on the epidemiology of PJI within hip and knee arthroplasty procedures. PJI occurred in 7761 and 16,798 THA and TKA cases in the USA, respectively, in 2010 and is projected to increase to 16,879 and 42,079 cases by 2020. In the USA and internationally, the overall incidence of PJI occurs in 0.7–2.3 % of both THA and TKA procedures. Infection is diagnosed within the first year postoperatively for 60 % of primary surgeries and the vast majority of cases occur within 2 years. Among the reasons for arthroplasty revision, infection is the second most prevalent failure mode in TKA and third for THA, and models project PJI will become the dominant failure mode by 2030. Regardless of revision reason, TKAs that have been previously revised have an increased incidence of infection of 8.3 % and are reported as high as 33 % among arthroplasties previously revised for infection. The most frequently reported risk factors were revealed to be gender, BMI > 50, extended-length procedures, lack of antibiotic bone cement, and comorbidities. Furthermore, treatment for PJI is 2.6–2.8 times more expensive than revision for aseptic loosening and is associated with 1.9–2.2 times longer patient hospital stay.