Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: In developed countries, certain health outcomes are worse among men. For example, in the US, life expectancy for men is 5 years shorter than for women and cardiovascular disease is a major contributor to this discrepancy. Little is known about how clinical features and outcomes of prosthetic joint septic arthritis (PJSA) differ between men and women. This is the first study of its kind to investigate these differences. Objective: To compare clinical characteristics and outcomes between women and men with surgically-treated PJSA.
Methods: We conducted a retrospective study that included all patients aged 18 and older admitted to a single, tertiary-care hospital between 1998 and 2015 diagnosed with monoarticular PJSA and treated surgically. We excluded all cases of osteomyelitis, polyarticular infection, septic bursitis, and native joint infection.
Results: Of the 225 patients with PJSA, 122 were female. The frequency of comorbid conditions was similar in men and women [Table 1]. However, a prior history of septic arthritis was more common in men (33 vs 21.3%, p=0.05). While there were no differences in rates of admission early after joint replacement (< 43 days), significantly more men developed late (>365 days after joint replacement) PJSA (59.8 vs 43.9%, p= 0.02). Women had significantly higher mean peripheral WBC counts (11.8 vs 10.3 x 109/L, p=0.03) and lower mean synovial fluid polymorphonuclear (PMN) cell counts (82.8 vs 89.9%, p=0.01) than their male counterparts. Males had higher rates of culture positivity (82.5 vs 69.7%, p=0.03) and presence of pus during surgery (68.9 vs 47.1%, p=0.005) but similar rates of MRSA infection [Table 2]. Finally, men were more likely to require ICU stay (17.5 vs 7.4%, p=0.02) and more frequently required multiple operations (29.4 vs 17.4%, p=0.05).
Conclusion: This study suggests there are significant gender differences in clinical features and outcomes of PJSA. Though the presentations were similar, men tended to present later (>1 year post joint replacement), have higher rates of culture positivity and worse outcomes. Further investigation is needed to better understand the causes of these differences and how they might be used to improve treatment. Table 1. Demographic, comorbidities, and clinical features of patients with PJSA, male vs. female.
| Female (n=122) | Male (n=103) | p-value | |
| Age (yrs), mean (SD) | 62.5 (15.5) | 61.9 (13.8) | 0.77 |
| Risk Factors for Septic Arthritis | |||
| DM, N (%) | 34 (27.9) | 35 (34) | 0.32 |
| HIV, N (%) | 2 (1.6) | 4 (3.9) | 0.3 |
| Prior History of Septic Arthritis, N (%) | 26 (21.3) | 34 (33) | 0.05 |
| RA, N (%) | 11 (9.0) | 8 (7.8) | 0.74 |
| Previous joint trauma, N (%) | 7 (5.7) | 8 (7.8) | 0.54 |
| Recent joint procedure, N (%) | 74 (61.2) | 56 (54.4) | 0.31 |
| Clinical features | |||
| Fever (>100 F), N (%) | 34 (27.9) | 36 (35) | 0.11 |
| Sepsis (defined by SIRS criteria), N (%) | 25 (20.5) | 25 (24.3) | 0.35 |
| Mean peripheral WBC (in thousands) (SD) | 11.8 (5.2) | 10.3 (5) | 0.03 |
| Mean peripheral PMN (%) (SD) | 77.5 (11.6) | 76.0 (10.3) | 0.36 |
| Mean ESR (mm/hr) (SD) | 68.9 (34.4) | 77.7 (37.5) | 0.11 |
| Mean CRP (mg/L) (SD) | 103.3 (94.2) | 128.8 (99.3) | 0.09 |
| Mean synovial fluid WBC (in thousands), (SD) | 67 (100.3) | 87.7 (138.2) | 0.25 |
| Mean synovial fluid PMN (%) (SD) | 82.8 (21.5) | 89.9 (14.6) | 0.01 |
| Affected Joint | |||
| Knee, N (%) | 89 (73) | 76 (73.8) | 0.89 |
| Hip, N (%) | 30 (25) | 25 (24.3) | 0.96 |
| SD: Standard deviation; DM: Diabetes Mellitus; HIV: Human Immunodeficiency Virus; RA: Rheumatoid arthritis; WBC: White blood cell; PMN: Polymorphonuclear leukocyte; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein | |||
Table 2. Outcomes of patients with PJSA, male vs. female
| Female (n=122) | Male (n=103) | p-value | |
| MSSA infection, N (%) | 71 (22.1) | 129 (29.9) | 0.02 |
| Detection of pus by surgeon, N (%) | 111 (55.8) | 168 (65.6) | 0.03 |
| ICU stay, N (%) | 9 (7.4) | 18 (17.5) | 0.02 |
| Multiple operations required, N (%) | 19 (17.4) | 27 (29.4) | 0.05 |
| Mean LOS (days) (SD) | 8.9 (5.3) | 10.2 (8.5) | 0.16 |
| Readmission within 60 days, N (%) | 21 (17.5) | 23 (22.5) | 0.3 |
| Expiration within 30 days | 2 (1.6) | 2 (1.9) | 0.8 |
| Discharge to rehabilitation, N (%) | 80 (66.7) | 57 (56.4) | 0.12 |
| MSSA: Methicillin-sensitive staphylococcal aureus; ICU: Intensive care unit; LOS: Length of stay | |||
To cite this abstract in AMA style:
Fowler ML, Lieber SB, Moore A, Shmerling R, Paz Z. Clinical Features and Outcomes of Prosthetic Joint Septic Arthritis: The Gender Effect [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/clinical-features-and-outcomes-of-prosthetic-joint-septic-arthritis-the-gender-effect/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-features-and-outcomes-of-prosthetic-joint-septic-arthritis-the-gender-effect/