Severe adverse events during medical and surgical treatment of hip and knee prosthetic joint infections

Introduction: The management of prosthetic joint infection requires a complex treatment procedure and can be associated with complications. However, the occurrence of severe adverse events during this intervention has been poorly evaluated. Patients and methods: A 5-year multicentric retrospective study including patients from 3 hospitals in the South-Western France referral center for complex bone and joint infections (Crioac GSO) and treated for hip or knee prosthetic joint infection with 1 or 2-stage implant exchanges. The objective was to describe grade >= 3 adverse events, according to the CTCAE classification, occurring within 6 weeks after surgery and to identify their associated factors. Results: One hundred and eighteen patients were identified. We observed 71 severe events in 50 patients (42.3%; 95% confidence interval [CI 95%]: 33.8-51.4%). Sixteen severe events were an evolution of the infection. The remaining 55 others (47 grade 3 and 8 grade 4) occurred in 41 patients (34.7%; CI 95%: 26.8-43.7%). They were distributed as follows: 27 (49.1%) medical complications, 21 (38.2%) surgical complications and 7 (12.7%) antibiotic-related complications. The main identified risk factor was a two-stage prosthetic exchange with OR = 3.6 (CI 95% [1.11-11.94], P= 0.032). Obesity was limit of significance with OR = 3.3 (CI 95% [0.9-12.51], P = 0.071). Infection with coagulase negative Staphylococcus was a protective factor with OR = 0.3 (CI 95% [0.12-0.99], P = 0.047). Conclusion: Severe adverse events are frequent following prosthetic exchange for PJI (34.7%) and are related to the high frequency of comorbidities in this population and to the complex surgical procedures required. The risk factor significantly associated with these events was a two-stage exchange. (C) 2020 Elsevier Masson SAS. All rights reserved.

Automated summary

The management of prosthetic joint infection is complex and can lead to severe adverse events. In this study, a 34.7% rate of severe adverse events was observed following prosthetic exchange for PJI, with the main risk factor being a two-stage exchange.