OBJECTIVES

Periprosthetic joint infection (PJI) is a disastrous complication associated with knee arthroplasty. The patient-related risk factors for periprosthetic joint infection in patients undergoing total knee arthroplasty are poorly understood. The purpose of this study was to identify the specific patient comorbidities that are associated with an increased risk of periprosthetic joint infection based on national health insurance database in Taiwan.

METHODS

Data were collected from the National Health Insurance Research Database of Taiwan. The study group included 187273 patients who aged over 60 years old and underwent total knee arthroplasty(TKA) during 2004 to 2013. The PJI was identified based on International Classification of Disease-Clinical Modification, ninth revision (ICD9-CM) code 99666 (PJI) who had received surgical treatment including debridement. The patient-related risk factors for PJI was analyzed.

RESULTS

In 187273 patients who underwent TKA, 3064 patients were identified as PJI, accounting 1.63%. Comorbid conditions associated with an increased adjusted risk of PJI were rheumatoid arthritis (HR:1.27), pre-operative anemia (HR:1.51), Diabetes mellitus (HR:1.28), General anesthesia then spinal anesthesia (HR:1.39), and blood transfusion (HR:1.76).

CONCLUSIONS

Specific patient comorbidities and perioperative condition and treatment that associated with PJI were identified. This information is important when counseling elderly patients regarding the risks of PJI following total knee arthroplasty, as well as for risk adjustment of publicly reported total knee arthroplasty outcomes.