ORTHOPEDICS THIS WEEK
VOLUME 13, ISSUE 38 | DECEMBER 5, 2017
in the department of orthopaedic sur-
gery at Kolding Hospital in Kolding,
Denmark, told OTW, “Three previous
papers have addressed this issue, but
they had mixed results. Two papers
stated that there was no increased risk
and one papers found an increasing
risk. Moreover, we believed there was
still doubt about whether the increased
mortality we believed our patients were
facing was due to the fact that they had
an infection or that only the vulnerable
patients—that were already in risk of
dying—got an infection.”
The authors wrote, “This population-
based cohort study was based on the
longitudinally maintained Danish Hip
Arthroplasty Registry on primary THA
[total hip arthroplasty] performed in
Denmark from 2005 to 2014.”
“Data from the Danish Hip Arthro-
plasty Registry were linked to microbi-
ology databases, the National Register
of Patients, and the Civil Registration
System to obtain data on microbiol-
ogy, comorbidity, and vital status on all
patients. Because reporting to the reg-
istry is compulsory for all public and
private hospitals in Denmark, the com-
pleteness of registration is 98% for pri-
mary THA and 92% for revisions (2016
annual report).”
Dr. Gundtoft commented to OTW,
“The key strength with the study is that
we were able to get complete data on
the microbiology reports from all the
intraoperative cultures. Furthermore,
we have exact time of death on all the
patients. The most important results
were that patients with PJI’s [prosthetic
joint infection] mortality risk within
one year is more than double that of
patients without, even when adjusting
for various confounder e.g., comorbid-
ity. Moreover, patients infected with
5
enterococcus are especially at risk of
dying within one year.”
“We should—in our daily work—pay
extra attention to these unfortunate
patients with PJI and do everything we
can to optimize their treatment. More-
over, we need close cooperation with
microbiologists to ensure that we treat
the patients—both pre and postop-
eratively—with the correct antibiotics.
This is because one of the reasons for
an increased mortality for patients with
enterococcus was that enterococcus has
intrinsic resistance to the most com-
mon used antibiotics used in revision
THA surgery. Patients with PJI have a
very high one-year mortality risk and
surgeons should be extremely aware of
the bacteria causing the PJI, as it can
influence their patient’s mortality.”
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