Secular trends in periprosthetic joint infections following primary hip and knee arthroplasties: A 15-year cohort study from the VINCat Program (2008-2022)

Abstract

Background: The VINCat program, established in Catalonia, Spain, in 2006, is a comprehensive infection prevention program for healthcare-associated infections. This study aims to analyze long-term trends in periprosthetic joint infections (PJI) following primary hip and knee arthroplasties over 15-year period (2008-2022).

Methods: PJI was defined according to CDC-NHSN criteria and updated in 2016 to incorporate the Musculoskeletal Infection Society classification. Data on PJI following total hip arthroplasty (THA), total knee arthroplasty (TKA), and hip hemiarthroplasty (HHA) were prospectively collected and analyzed across three periods: 2008-2012, 2013-2017, and 2018-2022.

Results: Sixty-seven hospitals participated in the surveillance, reporting 189,063 procedures, including 61,267 THA (median age: 69 years, 47% female), 115,940 TKA (median age: 73 years, 68% female), and 11,856 HHA (median age: 86 years, 73% females). PJI incidence rates for THA were 0.9%, 1.1%, and 1.2% across the three periods (odds ratio (OR):1.14, 95% CI: 0.96-1.35). For TKA, rates were 0.9%, 1.0%, and 0.9% (OR:0.95, 95% CI: 0.83-1.09). The incidence of HHA-PJI declined from 3.4% to 2.3% and 1.8% (OR:0.77, 95% CI:0.58-1.03). Overall, the most common etiology was coagulase negative staphylococci followed by Staphylococcus aureus. PJIs were diagnosed after hospital discharge in 87.1% of THA, 89.6% of TKA, and 73.9% of HHA.

Conclusions: The incidence of PJI remains low despite an aging population undergoing orthopedic surgery, highlighting the effectiveness of current infection prevention strategies. A robust, long-term surveillance system is crucial for monitoring epidemiological trends and guiding the implementation of evidence-based preventive measures.

Keywords: Arthroplasty; Artroplastia; Epidemiological surveillance system; Healthcare associated infections; Infecciones asociadas con la atención; Infecciones nosocomiales; Infección articular protésica o periprotésica; Nosocomial infections; Prevención y control; Prevention and contro; Prevention and control; Prosthetic or periprosthetic joint infection; Sanitaria; Sistema de vigilancia epidemiológica.