Second-site prosthetic joint infection in patients with multiple prosthetic joints

  • Kevin CleshamEmail author
  • Andrew J. Hughes
  • Sven O’ hEireamhoin
  • Catherine Fleming
  • Colin G. Murphy
Original Article • HIP - ARTHROPLASTY



Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections.


Our institution’s arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay.


Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs.


Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.


Prosthetic joint Infection Complication Arthroplasty Revision surgery 



I would like to thank all listed authors for their contribution to this manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interests to declare.


  1. 1.
    Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J (2010) Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 468(1):52–56CrossRefPubMedGoogle Scholar
  2. 2.
    Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J (2009) Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty 24(6 Suppl):105–109CrossRefPubMedGoogle Scholar
  3. 3.
    Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88(7):943–948CrossRefPubMedGoogle Scholar
  4. 4.
    Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S et al (2012) Increasing risk of prosthetic joint infection after total hip arthroplasty. Acta Orthop 83(5):449–458CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mortazavi SM, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J (2010) Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop Relat Res 468(8):2052–2059CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lentino JR (2003) Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 36(9):1157–1161CrossRefPubMedGoogle Scholar
  7. 7.
    Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD, Team I (2016) Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis. PLoS ONE 11(3):e0151537CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMedGoogle Scholar
  9. 9.
    Murray RP, Bourne MH, Fitzgerald RH (1991) Metachronous infections in patients who have had more than one total joint arthroplasty. J Bone Joint Surg Am 73(10):1469–1474CrossRefPubMedGoogle Scholar
  10. 10.
    Haverstock JP, Somerville LE, Naudie DD, Howard JL (2016) Multiple Periprosthetic Joint Infections: Evidence for Decreasing Prevalence. J Arthroplasty 31(12):2862–2866CrossRefPubMedGoogle Scholar
  11. 11.
    Jafari SM, Casper DS, Restrepo C, Zmistowski B, Parvizi J, Sharkey PF (2012) Periprosthetic joint infection: are patients with multiple prosthetic joints at risk? J Arthroplasty 27(6):877–880CrossRefPubMedGoogle Scholar
  12. 12.
    Cooper HJ, Della Valle CJ (2013) The two-stage standard in revision total hip replacement. Bone Joint J 95-B(11 Suppl A):84–87CrossRefPubMedGoogle Scholar
  13. 13.
    Workgroup Convened by the Musculoskeletal Infection S (2011) New definition for periprosthetic joint infection. J Arthroplasty 26(8):1136–1138CrossRefGoogle Scholar
  14. 14.
    Luessenhop CP, Higgins LD, Brause BD, Ranawat CS (1996) Multiple prosthetic infections after total joint arthroplasty. Risk factor analysis. J Arthroplasty 11(7):862–868CrossRefPubMedGoogle Scholar
  15. 15.
    Volin SJ, Hinrichs SH, Garvin KL (2004) Two-stage reimplantation of total joint infections: a comparison of resistant and non-resistant organisms. Clin Orthop Relat Res 427:94–100CrossRefGoogle Scholar
  16. 16.
    Salgado CD, Dash S, Cantey JR, Marculescu CE (2007) Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res 461:48–53PubMedGoogle Scholar
  17. 17.
    Lim SJ, Park JC, Moon YW, Park YS (2009) Treatment of periprosthetic hip infection caused by resistant microorganisms using 2-stage reimplantation protocol. J Arthroplasty 24(8):1264–1269CrossRefPubMedGoogle Scholar
  18. 18.
    Leung F, Richards CJ, Garbuz DS, Masri BA, Duncan CP (2011) Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res 469(4):1009–1015CrossRefPubMedGoogle Scholar
  19. 19.
    Cunningham DJ, Kavolus JJ 2nd, Bolognesi MP, Wellman SS, Seyler TM (2017) Specific infectious organisms associated with poor outcomes in treatment for hip periprosthetic infection. J Arthroplasty 32(6):1984–1990 e5CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN, Bozic KJ (2010) Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty 25(6 Suppl):103–107CrossRefPubMedGoogle Scholar
  21. 21.
    Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J (2008) Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 23(7):984–991CrossRefPubMedGoogle Scholar
  22. 22.
    Drago L, De Vecchi E, Cappelletti L, Mattina R, Vassena C, Romano CL (2014) Role and antimicrobial resistance of staphylococci involved in prosthetic joint infections. Int J Artif Organs 37(5):414–421CrossRefPubMedGoogle Scholar
  23. 23.
    Lenguerrand E, Whitehouse MR, Beswick AD, Jones SA, Porter ML, Blom AW (2017) Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res 6(6):391–398CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P et al (2009) One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63(6):1264–1271CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sendi P, Lotscher PO, Kessler B, Graber P, Zimmerli W, Clauss M (2017) Debridement and implant retention in the management of hip periprosthetic joint infection: outcomes following guided and rapid treatment at a single centre. Bone Joint J 99-B(3):330–336CrossRefPubMedGoogle Scholar
  26. 26.
    Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J (2013) Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 95(24):2177–2184CrossRefPubMedGoogle Scholar
  27. 27.
    Polanco-Armenta AG, Miguel-Perez A, Rivera-Villa AH, Barrera-Garcia MI, Sanchez-Prado MG, Vazquez-Noya A et al (2017) Risk factors for amputation in periprosthetic knee infection. Eur J Orthop Surg Traumatol 27(7):983–987CrossRefPubMedGoogle Scholar
  28. 28.
    Razii N, Abbas AM, Kakar R, Agarwal S, Morgan-Jones R (2016) Knee arthrodesis with a long intramedullary nail as limb salvage for complex periprosthetic infections. Eur J Orthop Surg Traumatol 26(8):907–914CrossRefPubMedGoogle Scholar
  29. 29.
    Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA (2014) The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 29(5):929–932CrossRefPubMedGoogle Scholar
  30. 30.
    Bozic KJ, Ries MD (2005) The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 87(8):1746–1751PubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Trauma and Orthopaedic SurgeryGalway University HospitalsGalwayIreland
  2. 2.Department of Infectious DiseasesGalway University HospitalsGalwayIreland

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