Is Climate Associated With Revision for Prosthetic Joint Infection After Primary TKA?

BACKGROUND: Climate factors have been shown to be associated with spontaneous musculoskeletal and some surgical site infections with increased rates of infection during warmer periods. To date, little research has been performed to determine if this phenomenon is associated with differences in the risk of revision for prosthetic joint infection (PJI) in primary TKA. QUESTIONS/PURPOSES: (1) Does the rate of revision for early PJI within the first year after primary TKA differ between tropical and nontropical regions? (2) Is there a seasonal variation in the rate of revision for PJI? (3) Is the geographic and seasonal variation (if present) associated with the sex, age, and/or American Society of Anesthesiologists (ASA) grade of the patient? METHODS: All 219,983 primary TKAs performed for osteoarthritis over a 5-year period (2011-2015) in the Australian Orthopaedic Association National Joint Replacement Registry were examined based on the month of the primary procedure to determine the rate of revision for PJI within 12 months. The data were analyzed to determine the differences in the risk of revision for PJI based on geographic region and season of the primary procedure adjusting for sex, age, and ASA grade of the patient. RESULTS: The early revision rate for PJI was higher in the tropical compared with the nontropical region of Australia (0.73% versus 0.37%; odds ratio [OR], 1.87; 95% confidence interval [CI], 1.44-2.42; p < 0.001). The tropical region of Australia demonstrated a seasonal variation in the rate of revision for PJI with a higher rate during the warmer monsoon wet season of summer and fall (summer/fall 0.98% versus winter/spring 0.51%; OR, 1.88; 95% CI, 1.12-3.16; p = 0.02). A seasonal variation was not seen in the nontropical region (OR, 1.03; 95% CI, 0.90-1.19; p = 0.64). The regional and seasonal changes were independent of sex, age, and ASA grade. CONCLUSIONS: Climate factors are associated with the risk of early revision for PJI in patients undergoing primary TKA with rates of such revisions approximately double in tropical regions compared with nontropical regions. Additionally, tropical regions demonstrate a seasonal variation with the risk of PJI doubling during the warmer, monsoonal wet season of summer and fall. These findings should be confirmed in further studies that can better control for possible confounding variables. The mechanism for this phenomenon is not clear, and further research into this subject is also indicated. LEVEL OF EVIDENCE: Level III, therapeutic study.

Humidity a potential risk factor for prosthetic joint infection in a tropical Australian hospital.

BACKGROUND: Many pathogens of importance, including the staphylococcal species of concern in orthopaedics, demonstrate seasonal variations influenced by environmental factors. The aim of this study was to investigate the role of humidity as a risk factor for deep prosthetic joint infection following total knee arthroplasty (TKA) in a tropical Australian hospital. METHODS: A retrospective cohort study of all TKAs performed over a 13-year period was conducted at the author's institution. Univariate analysis was used to individually assess for a range of risk factors including humidity >60% and apparent temperature >30°C (86°F). Odds ratios (ORs) were reported. P-values <0.25 were considered as potentially important risk factors and P-values <0.05 were considered statistically significant. RESULTS: A total of 1058 primary TKAs were performed with a deep prosthetic joint infection incidence of 2.7%. Four potential risk factors were identified with P-values <0.25: (i) humidity >60% (OR 1.4; 95% confidence interval (CI) 0.68-3.04; P = 0.221); (ii) apparent temperature >30°C (86°F) (OR 2.4; 95% CI 0.56-10.1; P = 0.174); (iii) male gender (OR 2.2; 95% CI 1.02-4.81; P = 0.057); and (iv) American Society of Anesthesiologists score of III or IV (OR 2.1; 95% CI 1.00-4.49; P = 0.064). CONCLUSION: Humidity and apparent temperature may be potentially important risk factors for infection following TKA.