Infections in the area of the articular prosthesis (PJI: Periprosthetic joint infection) in the elderly who have undergone total hip arthroplasty is indeed a possible scenario, but there is only little information on the subject. In a study whose findings were published in ‘The Bone & Joint Journal’, the researchers examined the characteristics of infection, surgical outcomes and perioperative complications in patients in their ninth decade of life who received treatment for PJI at a single university center.
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For this purpose, the researchers identified 33 patients who were treated for PJIs of the hip between January 2010 and December 2019 through the researchers’ institutional joint registry. The average age of the patients was 82 years (80 to 90), with 19 of them women (57%) and the average BMI was 26 kilograms/square meter (17 to 41). The average score of the patients according to the American Society of AnesthesiologistsJ(ASA) was 3 (1 to 4) and the mean Charlson Comorbidity Index score was 6 (4 to 10). The leading pathogens were coagulase-negative StaphylococciJ(45%) and – Enterococcus faecalisJ(9%) Two-stage replacement was performed in 30 joints, and permanent resection arthroplasty in three. The average duration of follow-up was five years (3 to 7). For the purpose of the study, the researchers conducted Kaplan-Meier survival analyses.
The 2-year survival rate without recurrent PJI was 72% (95% confidence interval, 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), with one due to the same pathogen found in the initial infection. One more infection was found at the surgical site after two weeks, which led to a survival of 69% (95% confidence interval 52 to 86; 17 patients at risk) without any infection for two years. Also, there were two cases of repairs due to dislocations, each after a month. Because of this, the 2-year survival without any revision was 61% (95% confidence interval 42 to 80; 12 patients at risk). In addition to the repairs mentioned above, in one case a skin graft was performed for a pressure ulcer, which led to a survival rate without any reoperation of 54% (95% confidence interval 35 to 73; ten patients at risk) at two years. The average Clavien-Dindo score for perioperative complications was two out of five, with one case of perioperative mortality noted at six days.
In conclusion, patients in their ninth decade of life who undergo surgery for PJI of the hip are at low risk for acute mortality, but are at moderate risk for other complications surrounding the surgery. One out of every two patients is expected to undergo repeat surgery within two years, with 70% of cases attributed to recurrent infections.
source:
Karczewski D, Schönnagel L, Hipfl C, Akgün D, Hardt S. Periprosthetic hip infection in octogenarians. Bone Joint J. 2023;105-B(2):135-139. doi:10.1302/0301-620X.105B2.BJJ-2022-1035.R1