Prosthetic Joint Infections of the Hip and Knee Among the Elderly:A Retrospective Study

Published:September 01, 2022DOI:



      As the population ages and demand for total joint arthroplasty increases, rates of periprosthetic joint infection (PJI) are expected to increase in the geriatric population. Studies comparing prevalence of risk factors, etiology, management, and mortality of prosthetic joint infection in older patients are lacking.


      We compared clinical characteristics, management, and mortality of patients <75 vs ≥ 75 years of age with first prosthetic joint infection of the hip or knee admitted to a tertiary medical center between September 2017 and December 2019.


      Ninety-eight patients (<75 years of age (n=63); ≥75 years of age (n=35) were studied.
      Groups were similar in terms of etiology, culture directed therapy, antibiotic suppression, and length of stay. There was no difference in surgical management, performed in almost 97% of cases in both groups. Arrhythmia and heart failure were more prevalent in those ≥75. Readmission related to prosthetic joint infection occurred less often in older individuals (p=0.005). Deaths within one year of diagnosis were rare (n=4; 4.1%), occurring in older patients and resulting mostly from sepsis.


      In our single-center study, patients with first prosthetic joint infection had similar management, regardless of age. We identified cardiac history as one of the host factors for prosthetic joint infection most seen in patients ≥75. Though deaths were rare, one-year mortality was higher in patients ≥75. Prospective, multi-center studies are needed to explore risk factors and management strategies of prosthetic joint infection among in elderly populations.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Del Pozo JL
        • Patel R.
        Clinical practice. Infection associated with prosthetic joints.
        N Engl J Med. 2009; 361: 787-794
        • Zimmerli W
        • Trampuz A
        • Ochsner PE.
        Prosthetic-joint infections.
        N Engl J Med. 2004; 351: 1645-1654
        • Sia IG
        • Berbari EF
        • Karchmer AW.
        Prosthetic joint infections.
        Infect Dis Clin North Am. 2005; 19: 885-914
        • Kurtz SM
        • Lau E
        • Watson H
        • Schmier JK
        • Parvizi J.
        Economic burden of periprosthetic joint infection in the United States.
        J Arthroplasty. 2012; 27 (Supple1): 61-65
        • Tande AJ
        • Patel R.
        Prosthetic joint infection.
        Clin Microbiol Rev. 2014; 27: 302-345
        • Bozic KJ
        • Ong K
        • Lau E
        • et al.
        Estimating risk in Medicare patients with THA: an electronic risk calculator for periprosthetic joint infection and mortality.
        Clin Orthop Relat Res. 2013; 471: 574-583
        • Gundtoft PH
        • Pedersen AB
        • Varnum C
        • Overgaard S.
        Increased Mortality After Prosthetic Joint Infection in Primary THA.
        Clin Orthop Relat Res. 2017; 475: 2623-2631
        • Kurtz SM
        • Lau EC
        • Son MS
        • Chang ET
        • Zimmerli W
        • Parvizi J.
        Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population.
        J Arthroplasty. 2018; 33: 3238-3245
        • Inoue D
        • Xu C
        • Yazdi H
        • Parvizi J.
        Age alone is not a risk factor for periprosthetic joint infection.
        J Hosp Infect. 2019; 103: 64-68
        • Aslam S
        • Darouiche RO.
        Prosthetic joint infections.
        Curr Infect Dis Rep. 2012; 14: 551-557
        • Osmon DR
        • Berbari EF
        • Berendt AR
        • et al.
        Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.
        Clin Infect Dis. 2013; 56: 1-10
        • Tan TL
        • Kheir MM
        • Shohat N
        • et al.
        Culture-Negative Periprosthetic Joint Infection: An Update on What to Expect.
        JB JS Open Access. 2018; 3: e0060
        • Tande AJ
        • Gomez-Urena EO
        • Berbari EF
        • Osmon DR.
        Management of Prosthetic Joint Infection.
        Infect Dis Clin North Am. 2017; 31: 237-252
        • Kurtz SM
        • Lau E
        • Schmier J
        • Ong KL
        • Zhao K
        • Parvizi J.
        Infection burden for hip and knee arthroplasty in the United States.
        J Arthroplasty. 2008; 23: 984-991
        • Abad CL
        • Haleem A.
        Prosthetic Joint Infections: an Update.
        Curr Infect Dis Rep. 2018; 20: 15
        • Nair R
        • Schweizer ML
        • Singh N.
        Septic Arthritis and Prosthetic Joint Infections in Older Adults.
        Infect Dis Clin North Am. 2017; 31: 715-729
        • Kapadia BH
        • Berg RA
        • Daley JA
        • Fritz J
        • Bhave A
        • Mont MA.
        Periprosthetic joint infection.
        The Lancet. 2016; 387: 386-394
        • Jamakorzyan C
        • Meyssonnier V
        • Kerroumi Y
        • et al.
        Curative treatment of prosthetic joint infection in patients younger than 80 vs. 80 or older.
        Joint Bone Spine. 2019; 86: 369-372
        • Prendki V
        • Ferry T
        • Sergent P
        • et al.
        Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study.
        Eur J Clin Microbiol Infect Dis. 2017; 36: 1577-1585
        • Prendki V
        • Sergent P
        • Barrelet A
        • et al.
        Efficacy of indefinite chronic oral antimicrobial suppression for prosthetic joint infection in the elderly: a comparative study.
        Int J Infect Dis. 2017; 60: 57-60
        • Prendki V
        • Zeller V
        • Passeron D
        • et al.
        Outcome of patients over 80 years of age on prolonged suppressive antibiotic therapy for at least 6 months for prosthetic joint infection.
        Int J Infect Dis. 2014; 29: 184-189
        • De Angelis G
        • Mutters NT
        • Minkley L
        • Holderried F
        • Tacconelli E.
        Prosthetic joint infections in the elderly.
        Infection. 2015; 43: 629-637
        • Macias-Valcayo A
        • Pfang BG
        • Aunon A
        • Esteban J.
        Pharmacotherapy options and drug development in managing periprosthetic joint infections in the elderly.
        Expert Opin Pharmacother. 2019; 20: 1109-1121
        • Orimo H
        • Ito H
        • Suzuki T
        • Araki A
        • Hosoi T
        • Sawabe M.
        Reviewing the definition of "elderly".
        Geriatrics and Gerontology International. 2006; 6: 149-158
        • Ouchi Y
        • Rakugi H
        • Arai H
        • et al.
        Redefining the elderly as aged 75 years and older: Proposal from the Joint Committee of Japan Gerontological Society and the.
        Geriatr Gerontol Int. 2017; 17: 1045-1047
        • Kunutsor SK
        • Whitehouse MR
        • Blom AW
        • Beswick AD
        • Team I.
        Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.
        PLoS One. 2016; 11e0150866
        • Bozic KJ
        • Lau E
        • Kurtz S
        • Ong K
        • Berry DJ.
        Patient-related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA.
        Clin Orthop Relat Res. 2012; 470: 130-137
        • Berbari EF
        • Hanssen AD
        • Duffy MC
        • et al.
        Risk factors for prosthetic joint infection: case-control study.
        Clin Infect Dis. 1998; 27: 1247-1254
        • Dalgaard F
        • Pallisgaard JL
        • Nume AK
        • et al.
        Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope.
        J Am Geriatr Soc. 2019; 67: 2023-2030
        • Gausden EB
        • Shirley MB
        • Abdel MP
        • Sierra RJ.
        Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty.
        Bone Joint J. 2021; 103-B (Supple A): 191-195
        • Ren X
        • Ling L
        • Qi L
        • et al.
        Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies.
        BMC Musculoskelet Disord. 2021; 22: 776
        • Beam E
        • Osmon D.
        Prosthetic Joint Infection Update.
        Infect Dis Clin North Am. 2018; 32: 843-859
        • Keller SC
        • Cosgrove SE
        • Higgins Y
        • Piggott DA
        • Osgood G
        • Auwaerter PG.
        Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery.
        Open Forum Infect Dis. 2016; 3: ofw176