Periprosthetic Joint Infection Doubles Long-Term Mortality Risk After Hip Replacement: Study
Researchers have found in a new study that Periprosthetic joint infection (PJI) following primary total hip arthroplasty (THA) is associated with a more than twofold increase in long-term mortality. Although complications after THA are uncommon, PJI can result in serious consequences, including repeat surgeries, prolonged hospital stays, extended antibiotic therapy, poor functional outcomes, and death. Evidence regarding its impact on medium- to long-term mortality has been limited and inconsistent, but this study highlights a significant association. The study was published in the Journal of Infection by Andreas W. and colleagues.
The study assessed data on 215,678 patients registered in the Swiss Joint Registry, of whom only 89,709 fulfilled the inclusion criteria. The distribution of male and female patients was equal in the sample population, as 51.3% of the participants were females. Additionally, the median age at which surgery was performed in the cohort was 69 years. The study followed the patients' progression for up to 10 years using Gompertz regression analysis to determine the adjusted hazard ratios (aHR) by accounting for various covariates like age, sex, BMI, and ASA physical status. Among this patient population, 745 patients (0.8%) developed PJI, whereas 2,752 patients (3.1%) had aseptic revision.
Key findings:
The patients with the diagnosis of PJI had an aHR for mortality of 2.15 (95% CI, 1.79-2.57; p<0.001), suggesting that the hazard for death was greater than twice that of patients without PJI.
However, the patients who underwent aseptic revision surgery were not shown to have any increased hazard of death with an aHR of 0.92 (95% CI, 0.80-1.06; p=0.27).
The highest mortality hazard was that posed by Enterobacterales at 3.17 (95% CI, 2.09-4.83).
The other organism responsible for posing a great hazard was highly virulent Staphylococcus aureus, which was responsible for an aHR of 2.32 (95% CI, 1.65-3.27).
Cutibacterium acnes, which is normally considered to be a slow-growing and less virulent organism, had a surprisingly higher mortality hazard of 2.31 (95% CI, 1.20-4.45).
Similarly, coagulase-negative staphylococci (CoNS) were associated with an increase in risk (aHR 1.65; 95% CI, 1.16–2.35).
On the contrary, there was no significant association between Streptococcal infections and increased mortality risk (aHR 1.24; 95% CI, 0.62–2.49).
This study provides evidence on the significance of the influence of periprosthetic joint infection on mortality in patients who have undergone total hip arthroplasty. This is based on the increased hazard rate of mortality due to PJI, twice the risk of revision surgery, and the higher mortality risks associated with the infections of particular bacteria, such as Enterobacterales and S. aureus. It must also be noted that the mortality risks caused by C. acnes are not insignificant, despite being considered non-pathogenic.
Reference:
Widmer, A., Imhasly, N., Brand, C., Zdravkovi, V., Spoerri, A., Schmidlin, K., Wicki, M., Beck, M., Sommerstein, R., & for SIRIS and SWISSNOSO (2026). Increased long-term mortality of patients with prosthetic joint infection after primary total hip arthroplasty - A large observational cohort study. The Journal of infection, 92(2), 106689. https://doi.org/10.1016/j.jinf.2026.106689
