Periprosthetic Joint Infection

BIOLOX® Ceramics Reduce Risk of Infection2

“Periprosthetic joint infection (PJI) is one of the most devastating complications of joint arthroplasty … the prevalence of PJI appears to be on the rise, with a projected number exceeding 60,000 to 70,000 hip and knee cases in the United States by 2023.”5

With a rate of <1% when considering all joint arthroplasties, it is among the most frequent causes of implant failure. PJI is the most common indication for revision total knee arthroplasty in the Medicare population6 and the third most frequent indication for revision total hip arthroplasty (15.6% of all hip revisions).4 It is projected that the annual cost to US hospitals of infected revisions will exceed by $1.62 billion in 2020.3

Revision Reasons THA

Chart 1: Revision Reasons THA

Revision reasons TKA

Chart 2: Revision Reasons TKA

Revision reasons for Shoulder Arthroplasty

Chart 3: Revision Reasons for Shoulder Arthroplasty

In principle, the causes of infection are multifactorial; however, the bearing couple has been demonstrated to have a significant influence (Chart 4).

Laboratory studies had already suggested that ceramics could be superior with regard to delivering the lowest possible infection rates.1 These studies compared ceramics with metals and polymers. Analysis based on data from 500’749 hip revisions has now confirmed the potential of ceramics in vivo.2

Studies, several of them implementing Cox multivariate analysis for confounding factors, and data from national registers are indicating that articulations involving a metal component are more prone to infection than those where the bearings are composed of ceramic against ceramic or ceramic against PE (30-50% less) where metal ion release is nil from the bearing and minimal from the taper junction.8

Chart 4: Revisions for Infection (500’749 pats)

Revisions for Infection (500’749 pats)

Chart 5: Rate of Revisions due to Periprosthetic Infection:
Infection risk with a metal-on-polyethylene articulation is 2.6 times higher than with ceramic-on-plyethylene.

References

  1. Liefheit K, Vergleichende Biofilmbildung auf Werkstoffe, Bericht, iba Heiligenstadt e.V. FB Biowerkstoffe, 2013
  2. Streicher R, Porporati A. News on ceramics – beyond wear reduction. Abstract EHS 2014, Streicher R, Leto A, Porporati A - News on ceramic – wear, corrosion and infection. Poster JHS 2014
  3. Kurtz SM1, Lau E, Watson H, Schmier JK, Parvizi J., Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep;27(8 Suppl):61-5.e1. doi: 10.1016/j.arth.2012.02.022. Epub 2012 May 2.
  4. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty 2009; 24:105-109.
  5. A Recurring Slippery Slope, Javad Parvizi, M.D., F.R.C.S., CURRENT CONCEPTS IN JOINT REPLACEMENT® Winter 2014 Hyatt Regency Grand Cypress, Orlando, Florida, December 10 - 13, 2014
  6. Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468:52-56.
  7. Calus Varnium, Alam B Pedersen, Per Kjaersgaard/Andersen, and Soren Overgaard. Comparison of the risk of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings. Acta Orthopaedica 2015;86 (3):x-x
  8. Smith L, Alijanipour P, Restrepo C, Maltenfort M, Parvizi J, Malkani A. Periprosthetic joint infection: could the bearing surface play a role? Abstract, Meeting of the Eastern Orthopaedic Association 2014
  9. S. Falcioni, C. Ancarani, B. Bordini, M.S. Pichierri, S. Stea Influence of articular coupling on septic loosening of total hip arthroplasty, 11th EHS Congress, Stockholm - Sweden, 9-11 October 2014 Hip Int 2014; 24 (5): 491
  10. National Joint Registry for England, Wales and Northern Ireland - 10th Annual Report 2013
  11. Rihard Trebše, Vesna Levašič , Simon Kovac Prosthetic Joint Infections and Bearings Abstracts from 11th EHS Congress, Stockholm - Sweden, 9-11 October 2014 Hip Int 2014; 24 (5): 491
  12. C. Varnum, A. b. pedersen, P. Kjaersgaard-Andersen and S. Overgaard, Comparison of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings- Data on 11096 patients from the Danish Hip Arthroplasty registry, Acta Orthpaedcia 2015, 86: x-x (doi:10.3109/17453674.2015.1012975)
  13. Kevin J. Bozic MD, MBA, Kevin Ong PhD, Edmund Lau MS, Steven M. Kurtz PhD, Thomas P. Vail MD, Harry E. Rubash MD, Daniel J. Berry MD Risk of Complication and Revision Total Hip Arthroplasty Among Medicare Patients with Different Bearing Surfaces Clinical Orthopaedics and Related Research® September 2010, Volume 468, Issue 9, pp 2357-2362
  14. Parvizi J. Periprosthetic joint infection: could the bearing surface play a role? CeraNews 1/2014, 11

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