Temporal association and risk factors for periprosthetic joint infection following erysipelas in total hip and knee arthroplasty

Purpose

Erysipelas is a cutaneous infection that primarily impacts the lower extremities. Research has suggested that patients with an existing prosthetic joint are at a heightened risk for the onset of a secondary prosthetic joint infection (PJI) following the development of erysipelas. This study aims to investigate the relationship between the incidence of erysipelas and specific patient-related risk factors in the context of PJI.

Methods

This study involved a retrospective analysis of medical records spanning from May 2016 to June 2021 at a tertiary referral center. A total of 289 patients who had developed erysipelas following hip or knee arthroplasty were included in the study. The present investigation has performed a targeted analysis focusing on the temporal relationship between the onset of erysipelas and the subsequent onset of PJI.

Results

Logistic regression analyses revealed that rheumatoid arthritis (RA) significantly heightened the risk of PJI following erysipelas, with an odds ratio (OR) of 8.24 (95% CI: 3.15–21.56). In the context of primary total hip arthroplasty (THA), both RA and heart failure (HF) were found to substantially elevate the risk of PJI post-erysipelas, corresponding to ORs of 43.74 (95% CI: 3.99–480.16) for RA and 11.38 (95% CI: 1.39–93.01) for HF, respectively. Likewise, in the cohort of primary total knee arthroplasty (TKA) patients, RA was linked to a heightened PJI risk, reflected by an OR of 10.34 (95% CI: 2.70 to 39.57). Notably, patients with RA experienced a significantly shorter mean timeframe until PJI occurrence (16.6 days, standard deviation 7.2), in contrast to patients with heart failure (mean 64.2 days, SD 79.5) and those without either RA or HF (mean 220.3 days, SD 52.2) (p < 0.001).

Conclusion

Our results highlight that specific risk factors including RA and HF significantly contribute to an increased risk of acute PJI following erysipelas. Notably, RA emerged as the strongest predictor, particularly in hip arthroplasty patients, where it was associated with a markedly elevated risk particularly in acute period. These findings support the need for individualized patient management strategies in early postoperative period, including optimizing perioperative immunosuppressant therapy in RA patients and implementing stringent postoperative surveillance protocols for high-risk individuals.

Level of evidence

Level III.