Infected Hip Research Articles

Prosthetic Hip Joint Infection: An Aluminium Mold for Intraoperative Production of Antibiotic-loaded Cement Hip Prostheses: 3 Cases Report

Introduction: To treat hip prosthetic infection, 2-stage revision, including removal and reimplantation, remains the standard treatment for prosthetic infection. Articulating cement spacer has been shown to provide better functional results after reimplantation. However, its cost as a manufactured product is not cheap and the choice of antibiotics is not flexible either. We designed an aluminium mold to make an antibiotic impregnated cement spacer, and replaced it between the first and the second stage. The current study was conducted to test their clinical efficacy.Case report: We report 3 cases of hip prosthetic infection treatment by using antibiotic impregnated cement spacer made by an aluminium mold. All patients presented to us in first 2-years postoperation and all had a deep infection. Three patients with infected total hip arthroplasties were treated with 2-stage revision using articulating spacers made by an aluminium mold and had a good result.Conclusion: Treating hip prosthetic infection with these articulating spacers eradicates infection effectively, improves the life quality before reimplantation and provides good final results without significant complications.

Reconstruction Plate-Based Antibiotic Cement Spacers: Clinical Outcomes and Description of Technique.

The standard of care for chronic deep peri-prosthetic hip infection is a two-stage exchange with placement of a temporary antibiotic cement spacer and treatment with intravenous antibiotics. Several commercially available cement spacer options exist. We report on a novel antibiotic spacer that may be an efficient, cost-effective alternative. Medical records of all patients treated for deep peri-prosthetic hip infection after total hip arthroplasty between 2004 and 2012 were reviewed. Each antibiotic spacer was constructed from a 12- to 16-hole recon plate bent to provide adequate soft tissue tension and a cement ball that matched the acetabulum. Premature failure of the plate and duration of implantation were measured. Failure was defined as fracture of the plate or dissociation of the cement head from the plate. Costs were compared with commercially available cement spacers. A total of 24 spacers were identified in 21 patients (mean age 68.9 years, mean body-mass index 26.4). The mean time between spacer placement and re-implantation was 6.4 months (range: 1.8-18 months). One patient had an indolent infection that was unresponsive to antibiotic therapy and required a hip disarticulation. At the time of reimplantation, 17 of 17 handmade spacers had no failures. Of the premade spacers, six of the seven had no failures. One premade spacer fractured at the femoral component trunion. The cost of the plate and antibiotic cement was $909-1000, approximately $5000 less than premade spacers. Antibiotic spacers can be readily constructed intraoperatively and offer good clinical outcomes with a low incidence of failure. This type of spacer saved $5000 per patient.

Charakterystyka izolatów Staphylococcus epidermidis wyhodowanych od pacjentów z zakażeniami endoprotez stawu biodrowego

Charakterystyka izolatów Staphylococcus epidermidis wyhodowanych od pacjentów z zakażeniami endoprotez stawu biodrowego

Long-term clinical outcome of two-stage revision surgery for infected hip arthroplasty using cement spacer: Culture negative versus culture positive.

Periprosthetic joint infection (PJI) is a terrible complication after hip arthroplasty. Clinical feature of culture-negative PJI (CN-PJI) has not been well studied till now. In our study, we retrospectively analyzed long-term clinical results after two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for CN-PJI. The purpose of this study is to investigate the clinical features and prognosis of CN-PJI after hip arthroplasty and to compare these with those of culture-positive PJI (CP-PJI). We retrospectively reviewed 15 CN-PJI cases and 70 CP-PJI cases following hip arthroplasty. The average follow-up period was 7.4 years (5-11.7 years). The demographics, laboratory findings, the time interval between antibiotic-impregnated cement spacer insertion and revision arthroplasty, and recurrence of infection were analyzed. The CN-PJI group showed a significantly higher incidence of prior antibiotic use ( p = 0.004) and lower serum C-reactive protein (CRP) level ( p = 0.001) than the CP-PJI group. Normalized time interval of CRP level in CN-PJI was shorter than that of CP-PJI group. The mean interval time for two-stage exchange arthroplasty was also significantly lower ( p = 0.049) in the CN-PJI group than the CP-PJI group. There was no case of treatment failure or major complication in CN-PJI group. The CN-PJI group after total hip arthroplasty could be treated successfully by two-stage exchange arthroplasty without any complications. Clinical course and prognosis of CN-PJI group was also better compared with that of CP-PJI group. Therefore, culture negativity of PJI cannot be always a poor prognostic factor for the treatment.

Early Treatment Result in a Patient with Periprosthetic Hip Infection

Typical errors in rendering specialized care to patients with chronic periprosthetic infection after total hip arthroplasty are demonstrated on the example of one patient. The role of patient examination with due regard for the complication risk factors, insufficient alertness in respect to postoperative infectious complications, absence of continuity at the steps of surgical treatment, complexity of eradication of infectious agent and need of multidisciplinary approach for rendering care to this group of patients is specially emphasized.

Use of an Artificial Ligament Decreases Hip Dislocation and Improves Limb Function After Total Femoral Prosthetic Replacement Following Femoral Tumor Resection

BackgroundHip dislocation is a major complication of total femoral prosthetic reconstruction (TFR) after femoral tumor resection. Hip dislocation can occur because of inadequate functional abductor musculature, inadequate hip capsule repair, or a long lever arm after total femur replacement. To eliminate the negative effects of these factors on the risk of hip dislocation, the use of artificial ligaments may help to increase the stability of the hip joint. We aimed to determine whether application of an artificial ligament would improve limb function and active range of movement (ROM) after TFR. MethodsFifty-eight patients who underwent femoral tumor resection and TFR were included. A band-shaped artificial ligament was wrapped spirally around the proximal site of the total femur prosthesis for periacetabular soft tissue reconstruction in 12 patients. The other 46 patients did not consent to receiving the artificial ligament. Complications including hip dislocation and infection, limb function, and active hip ROM were compared between patients who did and did not receive the artificial ligament. ResultsThe hip dislocation rate was lower in the patients who received the artificial ligament. The risk of deep infection did not differ between groups. The group that received the ligament also achieved better limb function and active ROM on flexion and abduction. ConclusionPatients treated with total femur resection and endoprosthetic replacement with an artificial ligament for periacetabular soft tissue reconstruction had a more stable hip joint, better limb function, and greater active hip ROM than did patients who did not receive an artificial ligament.

Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement.

The aim of the present study was to assess our management of infected total hip replacement in indications for 2-stage surgical treatment according to current guidelines when a cement spacer has been used. The study hypothesis was that the complications rate related to cement spacers is low. A single-center retrospective study included 26 patients receiving a spacer between the two stages of total hip replacement, over a 5 year period. We analyzed the spacers used, mechanical complications, infectious complications and the second stage of surgery. During the interval between surgeries, in the 26 patients, there were 19 spacer-related mechanical complications (73% of patients): 11 dislocations (42.3%), 5 spacer fractures (19.2%), 5 femoral bone lyses or fractures (19.2%) and 3 acetabular lyses or fractures (11.5%). In 4 cases, complications were associated. The greater the femoral offset of the spacer, the more frequent were femoral bone lyses or fractures (p=0.05), and the smaller the offset the more frequent were acetabular lyses or fractures (p=0.05). The rates of mechanical complications (p=0.003) and spacer fracture (p=0.02) were significantly greater in older patients. There were 4 cases of reinfection (19%): i.e., an 81% treatment success rate. One reinfection implicated a new bacterium: methicillin-susceptible Staphylococcus aureus. The second surgical stage was significantly longer in complex bipolar revision (p=0.009). The present results showed a high risk of spacer-related complications, and thus the importance of selection of patients liable to derive real benefit and those for whom a Gilderstone procedure would be preferable. IV, retrospective study.

Early treatment result in a patient with periprosthetic hip infection

Typical errors in rendering specialized care to patients with chronic periprosthetic infection after total hip arthroplasty are demonstrated on the example of one patient. The role of patient examination with due regard for the complication risk factors, insufficient alertness in respect to postoperative infectious complications, absence of continuity at the steps of surgical treatment, complexity of eradication of infectious agent and need of multidisciplinary approach for rendering care to this group of patients is specially emphasized.

Synovial aspiration and serological testing in two-stage revision arthroplasty for prosthetic joint infection: evaluation before reconstruction with a mean follow-up of twentysevenmonths.

The two-stage revision protocol is the gold standard for controlling and treating low-grade prosthetic joint infections of total hip and total knee arthroplasty. The antibiotic pause for diagnostic reasons before reconstruction (stage two) is discussed in relation to the persistence of the infection and the development of resistant bacterial strains. Serological markers and a synovial analysis are commonly used to exclude the persistence of infection. Therefore, we asked (1) is the serological testing of C-reactive protein and leucocytes a valuable tool to predict a persistence of infection? and (2) what is the role of synovial aspiration of Plymethylmethacrylat (PMMA) spacers in hip and knee joints? One hundred twelve patients who were MSIS criteria-positive for a prosthetic joint infection were studied, including 45 total hip arthroplasties (THA) and 67 total knee artrhoplasties (TKA) patients. All patients were treated with a two-stage-protocol using a mobile PMMA spacer after a 14-day antibiotic-free interval, during which we measured serological markers (C-reactive protein and leucocytes) and performed synovial aspiration (white blood cell count, polymorphonuclear cell percentage, and microbiological culture) in these patients and compared the results with those of their long-term-follow-up (mean follow-up 27months, range 24-36months). Of the 112 patients, 89 patients (79.5%; 95% CI 72-86.9) exhibited infection control after a two-stage exchange, and we detected most methicillin-resistant, coagulase-negative Staphylococci (CoNS) in cases of a persistent infection. The mean sensitivity of serum C-reactive protein in the patients was 0.43 (range 0.23-0.64), and the mean specificity was 0.73 (range 0.64-0.82). For serum leucocytes, the mean sensitivity was 0.09 (range 0-0.29), and the mean specificity was 0.81 (range 0.7-0.92). The mean sensitivity for the WBC count in the synovial fluid (PMMA spacer aspiration) was 0.1 (range 0-0.29), and the mean specificity was 0.79 (range 0.68-0.92). For the PMN percentage, the mean sensitivity was 0.1 (range 0-0.29), and the mean specificity was 0.79 (range 0.68-0.92). No cut-off values could be established for C-reactive protein, leucocytes, WBC count and PMN percentage due to the low AUC. No reliable markers were identified for the long-term persistence of infection. C-reactive protein and leucocytes were often elevated, even when the infection was controlled. In addition, normalized serum markers did not exclude the persistence of infection during follow-up. The synovial analysis of the WBC count and PMN percentage did not predict the persistence of infection. However, microbiological synovial fluid analysis is often misleading due to false positive microbiological cultures, which results in overtreatment.

Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management.

There are conflicting data on the results of irrigation and debridement with component retention in patients with acute periprosthetic hip infections. The goals of this study were to examine contemporary results of irrigation and debridement with component retention for acute infection after primary hip arthroplasty and to identify host, organism, antibiotic, or implant factors that predict success or failure. Ninety hips (57 total hip arthroplasties and 33 hemiarthroplasties) were diagnosed with acute periprosthetic hip infection (using strict criteria) and were treated with irrigation and debridement and component retention between 2000 and 2012. The mean follow-up was 6 years. Patients were stratified on the basis of McPherson criteria. Hips were managed with irrigation and debridement and retention of well-fixed implants with modular head and liner exchange (70%) or irrigation and debridement alone (30%). Seventy-seven percent of patients were treated with chronic antibiotic suppression. Failure was defined as failure to eradicate infection, characterized by a wound fistula, drainage, intolerable pain, or infection recurrence caused by the same organism strain; subsequent removal of any component for infection; unplanned second wound debridement for ongoing deep infection; and/or occurrence of periprosthetic joint infection-related mortality. Treatment failure occurred in 17% (15 of 90 hips), with component removal secondary to recurrent infection in 10% (9 of 90 hips). Treatment failure occurred in 15% (10 of 66 hips) after early postoperative infection and 21% (5 of 24 hips) after acute hematogenous infection (p = 0.7). Patients with McPherson host grade A had a treatment failure rate of 8%, compared with 16% (p = 0.04) in host grade B and 44% in host grade C (p = 0.006). Most treatment failures (12 of 15 failures) occurred within the initial 6 weeks of treatment; failures subsequent to 6 weeks occurred in 3% of those treated with chronic antibiotic suppression compared with 11% of those who were not treated with suppression (hazard ratio, 4.0; p = 0.3). The success rate was higher in this contemporary series than in many previous series. Systemic host grade A was predictive of treatment success. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Этиология острой перипротезной инфекции суставов и результаты ее хирургического лечения

Introduction Surgical treatment of acute periprosthetic infection is possible with the technique of debridement and replacement of only modular components of the implant, provided that the implant is stable. Positive outcomes by using this technique in the acute infection phase range between 85 and 100 % while in the chronic phase they the success range is only 0–50 %. This is explained by the ability of bacteria to form biofilms on metal and polyethylene implant surfaces. Material and methods We conducted the analysis of the treatment results in 35 patients with acute periprosthetic infection of the hip and knee joints. They all had joint debridement with replacement of the modular components of their implants. The implant elements removed were examined for the presence of biofilms and its pathogenic microorganisms. Results Laboratory methods of investigation revealed that irreversible biofilm types were found on the surface of the removed components of the implants in all patients if periprosthetic infection was manifested for more than 2 weeks. Arrest of the infectious process was achieved only in 10 patients (66.7 %) with knee pathology and in 11 patients (55 %) with infected hip joint area. Discussion The main cause of acute postoperative and hematogenic infection of joints is an isolated gram-positive microflora, which is observed in more than 50 % of cases. Irreversible biofilm types on the surface of the implant components in the patients with the duration of periprosthetic infection for more than 2 weeks explain the high rate of purulent process recurrence which reaches 33.3 % after debridement in infected knees and 45 % after debridement in the hip joints. Conclusion It seems worth reviewing the indications for the technique of debridement by which not all the elements of the implant are changed and reduce its use if infection lasts for more than 2 weeks. However, this assumption requires further study.

Cementless One-Stage Revision in Chronic Periprosthetic Hip Joint Infection. Ninety-One Percent Infection Free Survival in 56 Patients at Minimum 2-Year Follow-Up

BackgroundCementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group. MethodsThe study was performed as a multicenter, proof-of-concept, observational study with prospective data collection. Patients were treated with a cementless 1-stage revision according to the CORIHA protocol between 2009 and 2014. Fifty-six patients, McPherson type III-A/B-1/2, were enrolled with a mean follow-up time from the CORIHA procedure of 4 years (minimum of 2 years). The primary outcome was re-revision performed due to infection and was evaluated by competing risk analysis, with death and aseptic revision as competing events. All-cause mortality was evaluated by Kaplan-Meier survival analysis. Oxford Hip Score (OHS) was used as disease-specific patient-reported outcome measure. ResultsThe cumulative incidence of re-revision due to infection was 8.9% (confidence interval [CI] 3.2%-18.1%). The 1-year and 5-year survival incidence was 96% (CI 86%-99%) and 89% (CI 75%-95%). OHS at baseline was 19.9 (CI 17.3-22.6) and at 24-month follow-up 35.1 (CI 31.7-38.5). The mean change in OHS from baseline to 24-month follow-up was 11.8 points (CI 7.3; 16.3). Three patients had aseptic revision performed: two suffered periprosthetic fractures and one had stem subsidence. Failure analysis of the 5 reinfections did not detect a clear pattern as to the cause of failure. ConclusionWe found that cementless 1-stage revision in chronic periprosthetic hip joint infections has low reinfection rates in selected patients and may be applicable as a first-line treatment.

Incidence of hip and knee prosthetic infections in a specialised centre of Mexico City

Incidence of hip and knee prosthetic infections in a specialised centre of Mexico City

Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies.

The aims of the study were to review and analyse the reported series of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip arthroplasties (THAs) to establish the overall success and the influencing factors. Using a standardised recognised study protocol, meta-analysis of observational studies in epidemiology guidelines, a comprehensive review and analysis of the literature was performed. The primary outcome measure was the success of treatment. The search strategy and inclusion criteria which involved an assessment of quality yielded 39 articles for analysis, which included 1296 patients. The proportion of success following DAIR in the management of an infected THA appeared to improve after 2004 with a pooled mean proportion of success of 72.2%. For all reported series, from 1977 onwards, there was improved success with early debridement (< 7 days; 75.7%) and exchange of modular components (77.5%). There was a statistically non-significant improvement if debridement was performed within four weeks of the initial procedure (73.0%). The reported success following DAIR has improved since 2004. The only determinants of outcome which we found were the timing of debridement after the onset of symptoms of infection and the exchange of modular components. Cite this article: Bone Joint J 2017;99-B:1488-66.

Uncommon carbapenemase-encoding plasmids in the clinically emergent Acinetobacter pittii.

Two carbapenemase-carrying plasmids, pLS488 (blaOXA-23) and pLS535 (blaOXA-58) from Acinetobacter pittii clinical isolates, were characterized in this study, including their ability to be transferred to Acinetobacter baumannii. The clinical isolates were obtained from drainage fluid of a patient with biliary tract cancer and from an exudate of a patient with a hip infection (Portuguese University Hospital, 2012). Isolate characterization included antimicrobial susceptibility tests, carbapenemase production by Blue-Carba, carbapenem-hydrolysing class D β-lactamase (CHDL) gene search by PCR sequencing, ApaI-PFGE, CHDL genetic location and plasmid size by hybridization and WGS. Plasmid transfer was performed by conjugation or electroporation. pLS488 constitutes the first conjugative plasmid reported to carry a carbapenem resistance gene in A. pittii and is part of a potential new incompatibility group that might also account for the dissemination of OXA-23 in A. baumannii. pLS535 belongs to the Acinetobacter GR7 incompatibility group and presents a new scaffold for OXA-58. This plasmid lacked the machinery for conjugation, but was transferable by electroporation to A. baumannii. Both isolates, which displayed the same PFGE pattern, represent the first report of CHDL-carrying A. pittii in Portuguese hospitals. Altogether, these results emphasize the importance of A. pittii, or particular A. pittii clones, as a source of resistance genes, facilitating their dissemination among different bacterial species.

Two-stage total hip arthroplasty using an antibiotic-loaded cement spacer for infected internal fixation of hip fractures

Objective: To evaluate the application and clinical results of two-stage total hip arthroplasty in the treatment of the deep hip infection following the internal fixation of hip fractures. Methods: From May 2007 to November 2014, 21 patients with active hip infection secondary to internal fixation of hip fractures were treated with two-stage total hip arthroplasty using a temporary antibiotic-loaded cement spacers. Of 21 cases, 15 were males and 6 were females, aged from 27 to 64 years (mean, 45); there are 18 cases of femoral neck fractures and 3 cases of intertrochanteric fractures. The serologic examination and X-ray were taken at 1 month, 3 months, 6 months, 12 months and annually thereafter post-operatively to evaluate the clinical results and prosthesis status. Harris hip score system was used to evaluate the joint function. Results: All patients were successfully treated with two stage operations under general anesthesia. The operational interval was 12-44 weeks (mean, 21) and 1 spacer breakage. For the arthroplasty, cementless components were used in 20 cases and cemented component was use in 1 case. The patients were followed up 25-102 months ( mean, 55 ) and infections were eradicated in all hips. The Harris hip score was improved from 23.24±11.81 pre-operatively to 90.24±3.92 post-operatively and the difference was statistically significant (P<0.05). According to this scoring criteria, the excellent and good rate reached up to 95%. At latest fellow-up, the location of prosthesis were well and the function of hip joint was satisfied. All cases had no dislocation, periprosthetic fracture, ectopic ossification or any other complications at the latest fellow-up. Conclusion: By means of an antibiotic-loaded cement spacer, two-stage total hip arthroplasty is an effective salvage procedure eradicating infection and providing functional improvement to the infected internal fixation of hip fractures. The early and mid-term clinical effects are satisfied.

Цитокины и микробиоценоз в прогнозировании течения послеоперационного периода у пациентов с перипротезной инфекцией тазобедренного сустава после удаления инфицированного эндопротеза

Цитокины и микробиоценоз в прогнозировании течения послеоперационного периода у пациентов с перипротезной инфекцией тазобедренного сустава после удаления инфицированного эндопротеза

Systemic Absorption of Antibiotics From Antibiotic-Loaded Cement Spacers for the Treatment of Periprosthetic Joint Infection

BackgroundTwo-stage treatment of periprosthetic joint infections involves placement of high-dose antibiotic-loaded cement spacers (ACSs). Reports of ACS-induced nephrotoxicity have raised concern regarding systemic absorption of antibiotics after ACS placement. We sought to characterize the serum concentrations of antibiotics that occur after ACS placement. MethodsWe performed a prospective study of patients with an infected primary total hip (THA) or knee arthroplasty (TKA) treated with standardized ACSs with vancomycin, gentamicin, and tobramycin. Serum antibiotic levels were collected weekly for 8 weeks. ResultsTwenty-one patients (10 THA, 11 TKA) were included. Mean serum gentamicin levels ranged between 0.275±0.046 and 0.364±0.163 mg/L; mean serum tobramycin levels ranged from 0.313±0.207 to 0.527±0.424 mg/L; and mean serum vancomycin levels ranged from 5.46±6.6 to 15.34±9.6 mg/L. Serum antibiotic levels were detectable throughout the 8-week duration of ACS treatment. Regression analysis found that diabetes (coefficient 6.73, 95% CI 0.92-12.54, P < .05), blood urea nitrogen (coefficient 0.83, 95% CI 0.45-1.22, P < .001), number of cement doses (coefficient 3.71, 95% CI 0.76-6.66, P < .05), and use of systemic vancomycin (coefficient 6.24, 95% CI 2.72-9.75, P < .001) correlated with serum vancomycin levels. Patient age (coefficient −0.01, 95% CI −0.02 to 0, P < .01) and male sex (coefficient 0.20, 95% CI 0-0.41, P < .05) correlated with serum aminoglycoside level. ConclusionSystemic absorption of antibiotics from high-dose ACS persists for at least 8 weeks. Patients should be monitored closely for complications related to systemic absorption of antibiotics from ACS treatment.

Assessment of Musculoskeletal Infection Society (MSIS) Diagnostic Criteria as Predictors of Treatment Success in Hip Arthroplasty Infections Treated with Two-Stage Exchange

Background Prosthetic joint infection (PJI) is a grave complication of total hip arthroplasty (THA). Predicting outcome is difficult. Musculoskeletal Infection Society (MSIS) criteria are sensitive and specific for the diagnosis of PJI. In prior work, we systematically studied the value of each MSIS criterion as a prognostic marker among a large cohort of patients with infected hip and knee arthroplasty treated with debridement, antibiotics, and implant retention (DAIR) at our specialized orthopedic hospital. We found that sinus tract drainage and culture positivity predicted explantation within 2 years of DAIR; the minor MSIS criteria were not predictive. Here, we sought to evaluate the utility of MSIS criteria in predicting outcomes of infected THR PJI treated with two-stage exchange arthroplasty. We sought to evaluate whether MSIS criteria can predict outcome of infected THR PJI treated with two-stage exchange arthroplasty.Methods A retrospective cohort of PJI from 2007 to 2014 treated with two-stage exchange was identified via an administrative database. Two-year implant retention was the primary outcome. Collected data included demographics and comorbidities, duration of symptoms, implant age, and pathogen. Continuous variables were assessed using the Mann–Whitney U-tests and categorical variables using the χ 2 test and Fisher’s exact test when appropriate.ResultsOne hundred and thirty patients who underwent two-stage exchange for THA PJI meeting MSIS criteria were identified. Ninety percent remained infection free after 2 years of observation. Neither of the major criteria [the presence of sinus drainage[(P = 0.5416), and >1 positive culture (P = 0.1052)], nor any of the minor criteria, reached statistically significant association with treatment outcome.Conclusion Individual MSIS diagnostic criteria, which do have prognostic utility in hip and knee PJI treated with DAIR, may not be powerful predictors of outcome of hip PJI after two-stage exchange, likely in part because of the high success rate of this procedure.Disclosures All authors: No reported disclosures.

Risk Factors for Early Hip or Knee Prosthetic Joint Infection (PJI): Analysis of a Nationwide American Insurance Claims Dataset

BackgroundWhile several studies have identified risk factors for PJI using insurance claims data, these data sets have been limited to a single regional insurance dataset or to the Medicare population. We sought to investigate risk factors for early PJI among patients undergoing total hip or knee arthroplasty (THKA).MethodsAll patients who underwent primary THKA between January 1, 2004 and July 31, 2014 with 12 months of continuous preceding medical and pharmacy insurance coverage were included in the study. The primary outcome of PJI required both a compatible procedure code and a diagnostic code during an inpatient stay from the time of THKA through 90 days after discharge. Comorbidities were based on ICD-9 codes in the preceding 12 months and patients with a prior diagnosis of PJI during that time period were excluded. Univariate and multivariate analysis was performed using logistic regression.ResultsA total of 147,053 patients underwent THKA during the study period, including 97,448 patients with TKA and 49,605 with THA. PJI occurred in 754 (0.5%) patients. Female gender was independently associated with lower odds of PJI (Figure). A number of biologically plausible factors were associated with increased risk, including chronic skin ulcer, obesity, substance use disorders, joint sarcoma, and malnutrition. The adjusted odds of PJI increased in a stepwise fashion with each increase in the Charlson comorbidity index (CCI), with those with a score of 4 or more having a nearly 2-fold adjusted odds of PJI compared with a score of 0 (OR 1.91; 95% CI 1.29 −2.82). Previously observed risk factors diabetes mellitus, rheumatoid arthritis, and chronic renal failure were associated with increased odds of PJI on univariate analysis, but not after adjustment.ConclusionThese data identify several potentially modifiable risk factors for preoperative optimization, including obesity, malnutrition, chronic skin ulcers, and substance-use disorders. The level of comorbidity as assessed by the CCI provides a rough estimate of the increasing risk of PJI. The pathobiology of additional risk factors observed here deserves further study.Disclosures All authors: No reported disclosures.