Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: a systematic review and meta-analysis

Abstract

Abstract Background Whether a history of native hip or knee septic arthritis is associated with an increased risk of periprosthetic joint infection (PJI), aseptic revision, or reoperation after total joint arthroplasty (TJA) remains unclear. This meta-analysis aimed to evaluate whether patients with a history of native hip or knee septic arthritis (septic arthritis group) are at higher risk of PJI, aseptic revision, and reoperation after primary TJA than those without (nonseptic arthritis group). We hypothesized that a history of septic arthritis is associated with an increased risk of complications after TJA. Methods A systematic literature search of MEDLINE, Embase, and the Cochrane Library was conducted to identify studies comparing the outcomes of primary TJA between patients with a history of native hip or knee septic arthritis and those without. Previous studies reporting postoperative infection, aseptic revision, or reoperation rates were included in the analysis. The septic arthritis group comprised patients with sequelae of childhood joint infection and those who underwent one- or two-stage TJA for active or previously treated septic arthritis. Random-effects meta-analyses were performed to calculate pooled risk ratios with 95% confidence intervals. Results This research included seven studies, comprising 5,842 arthroplasties in the septic arthritis group (THA: 1,351; TKA: 4,491) and 10,589 arthroplasties in the nonseptic arthritis group (THA: 5,299; TKA: 5,290). Patients with a history of septic arthritis were at significantly higher risk of postoperative PJI than those without, with substantial heterogeneity. The risk of aseptic revision did not significantly differ between the septic arthritis and nonseptic arthritis groups. However, patients with a history of septic arthritis were at significantly higher risk of reoperation. Conclusions Patients with a history of native hip or knee septic arthritis are at significantly higher risk of postoperative infection and reoperation after total joint arthroplasty compared with those without a history of joint infection. Surgeons should be aware of the increased risk of complications in this high-risk population. Nevertheless, further studies should be performed to determine the optimal timing of arthroplasty after septic arthritis and to identify strategies that can reduce postoperative complications.