THE MORTALITY OF PERIPROSTHETIC JOINT INFECTION IN NON-SPECIALIST HOSPITALS WITHIN THE UK

Aim To assess mortality of peri-prosthetic joint infection treated in non-specialist hospitals within the UK. Methods A retrospective review of patients with EBJIS confirmed hip or knee PJI, treated between 2014 and 2023 in 5 non-specialist infection hospitals was performed. Demographic information, procedural information and most recent follow-up were recorded. Patients presenting with acute sepsis were excluded. Mortality was compared to the 5 most common malignancies diagnosed in the UK. The primary outcome was mortality at 1 to 5 years after surgery. Results 223 patients met the inclusion criteria for PJI during the study period. All patients underwent surgery which was either debridement antibiotics and implant retention (DAIR) (n=117), wound washout (n=45), removal of prosthesis for two-stage revision surgery (n=33), or single-stage revision (n=28). The overall one-year survival following the index procedure for PJI was 88.5%, two-year survival was 78.2% and five-year survival was 48.3%. Compared to the age-matched UK general population, patients having surgery for PJI aged between 50 and 60 years had a 5.0 times increased risk of death (95%CI 3.6-6.4) and those between 60 and 70 years had a 2.3 times increased risk of death (95%CI 2.0-2.7). Controlling for age, mortality for those classified as JS-BACH ‘complex’ (HR3.1; 95% CI 1.1-8.8) or JS-BACH ‘limited options’ (HR 15.1; 95%CI 4.6-49.0) was significantly higher compared to JS-BACH ‘uncomplicated’. Compared to the most common malignancies within the UK, the 1-year and 5-year survival was similar to that of colorectal cancer, worse than breast cancer, prostate cancer and melanoma but better than lung cancer. Conclusions Mortality after PJI has previously been underestimated. In oncology, there has been a major improvement in survival in many common cancers, due to development of multidisciplinary centres focussed on delivering all components of patient care. This now needs to be replicated for PJI.