The incidence of late prosthetic joint infections: A registry-based study of 112,708 primary hip and knee replacements

BACKGROUND AND PURPOSE: Late prosthetic joint infections (PJIs) are a growing medical challenge as more and more joint replacements are being performed and the expected lifespan of patients is increasing. We analyzed the incidence rate of late PJI and its temporal trends in a nationwide population. PATIENTS AND METHODS: 112,708 primary hip and knee replacements performed due to primary osteoarthritis (OA) between 1998 and 2009 were followed for a median time of 5 (1–13) years, using data from nationwide Finnish health registries. Late PJI was detected > 2 years postoperatively, and very late PJI was detected > 5 years postoperatively. RESULTS: During the follow-up, involving 619,299 prosthesis-years, 1,345 PJIs were registered: cumulative incidence 1.20% (95% CI: 1.13–1.26) (for knees, 1.41%; for hips, 0.92%). The incidence rate of late PJI was 0.069% per prosthesis-year (CI: 0.061–0.078), and it was greater after knee replacement than after hip replacement (0.080% vs. 0.057%, p = 0.006). The incidence rate of very late PJI was 0.051% per prosthesis-year (CI: 0.042–0.063), 0.058% for knees and 0.044% for hips (p = 0.2). The incidence rate of late PJI varied between 0.041% and 0.107% during the years of observation without any temporal trend (incidence rate ratio (IRR) = 0.98, 95% CI: 0.93–1.03). Very late PJI increased from 0.026% in 2004 to 0.056% in 2010 (IRR = 1.11, 95% CI: 1.02–1.20). INTERPRETATION: In our nationwide study, the incidence rate of late PJI after hip or knee arthroplasty was approximately 0.07% per prosthesis-year. The incidence of very late PJI appeared to increase.