Risk factors of implant infection and revision joint replacement identified in UK study

infection and revision joint replacement

Hip replacement surgery is a very common operation nowadays with an excellent success rate. Over 100,000 patients per year undergo this type of operation, and it is commonly used to treat chronic, debilitating conditions such as osteoarthritis. Total hip replacements are proven to make significant improvements to quality of life, including mobility, reduction of pain and an improvement of patients’ general well-being, but as with all surgeries, there is a small risk of complications developing post-operatively.

One risk is that patients could develop a prosthetic joint infection, or PJI. This is a rare complication, affecting around 1% of patients.  The consequences of a PJI are not to be underestimated.  A study from Bristol University published in the Lancet Infectious Diseases medical journal describes it as a ‘devastating complication’ following joint replacement surgery.  A PJI can lead to “severe pain, poor function, reduced quality of life, and even death.” Treatment to cure a PJI can also be tough and gruelling for patients and usually requires revision joint replacement surgery to get rid of the infection.

With this in mind, a cohort of doctors have been analysing data collected over many years of joint replacement surgery to see whether they can identify patterns of who might be at greatest risk of developing a PJI following surgery for total hip replacement.

Risk factors for infection and revision joint replacement

The study used data from the UK National Joint Registry over 11 years and concluding in March 2018, with over 600,000 cases.  Risk factors for the development of PJI were identified.

The following were identified that correlated with a higher chance of developing a PJI:

  • Younger patients (under 60 years old)
  • Patients with a high BMI
  • Those already reporting chronic pulmonary disease, liver disease, or dementia
  • Hip replacement performed for a hip fracture

These factors seemed to reduce the risk of infection:

  • The use of a posterior approach
  • The use of ceramic as the bearing material

This news is encouraging and supports the approach undertaken at Mr Simon Bridle’s London hip replacement clinic as he prefers to operate using the posterior approach and using ceramic bearings for the artificial joints.

These results give a very clear steer regarding heightened risks for certain groups of the population and, armed with this information, surgeons are able to more accurately advise patients and can take steps to help manage/reduce the associated risks for these groups. Work will now be undertaken to understand whether the same patterns are identified for patients who undergo knee replacement surgery, to see if there are parallels found between the two types of operation.