TY - JOUR
T1 - Incidence, temporal trends and potential risk factors for prosthetic joint infection after primary total shoulder and elbow replacement
T2 - Systematic review and meta-analysis
AU - Kunutsor, Setor K
AU - Barrett, Matthew C
AU - Whitehouse, Michael R
AU - Craig, Richard S
AU - Lenguerrand, Erik
AU - Beswick, Andrew D
AU - Blom, Ashley W
PY - 2020/4/1
Y1 - 2020/4/1
N2 - OBJECTIVES: We conducted a systematic meta-analysis to evaluate the incidence, temporal trends and potential risk factors for prosthetic joint infection (PJI) following primary total shoulder replacement (TSR) and elbow replacement (TER).METHODS: Longitudinal studies reporting infection outcomes following primary TSR or TER were sought from MEDLINE, Embase and Cochrane Library up to June 2019. Incidence rates and relative risks (with 95% CIs) were calculated.RESULTS: The search identified 105 eligible articles (108 non-overlapping studies). There were 631,854 TSRs (1,751 PJIs) and 17,485 TERs (525 PJIs). The pooled PJI incidence following TSR was 0.61% (0.34-0.93) over a follow-up period of 1.1 years. The corresponding incidence following TER was 2.53% (1.99-3.12) over a follow-up period of 3.3 years. Shoulder and elbow PJI incidence declined from the 1990s to 2010 and beyond. Males, younger age (<75 years), previous shoulder surgery, reverse TSR, rotator cuff arthropathy and inpatient TSR increased shoulder PJI risk. For TER, high body mass index, psychiatric illness, and previous elbow surgery increased PJI risk.CONCLUSIONS: Shoulder and elbow PJI may be on a temporal decline. Caution should be taken for patients at high PJI risk following primary TSR such as younger males and patients with a previous shoulder surgery.
AB - OBJECTIVES: We conducted a systematic meta-analysis to evaluate the incidence, temporal trends and potential risk factors for prosthetic joint infection (PJI) following primary total shoulder replacement (TSR) and elbow replacement (TER).METHODS: Longitudinal studies reporting infection outcomes following primary TSR or TER were sought from MEDLINE, Embase and Cochrane Library up to June 2019. Incidence rates and relative risks (with 95% CIs) were calculated.RESULTS: The search identified 105 eligible articles (108 non-overlapping studies). There were 631,854 TSRs (1,751 PJIs) and 17,485 TERs (525 PJIs). The pooled PJI incidence following TSR was 0.61% (0.34-0.93) over a follow-up period of 1.1 years. The corresponding incidence following TER was 2.53% (1.99-3.12) over a follow-up period of 3.3 years. Shoulder and elbow PJI incidence declined from the 1990s to 2010 and beyond. Males, younger age (<75 years), previous shoulder surgery, reverse TSR, rotator cuff arthropathy and inpatient TSR increased shoulder PJI risk. For TER, high body mass index, psychiatric illness, and previous elbow surgery increased PJI risk.CONCLUSIONS: Shoulder and elbow PJI may be on a temporal decline. Caution should be taken for patients at high PJI risk following primary TSR such as younger males and patients with a previous shoulder surgery.
KW - incidence
KW - temporal trends
KW - risk factor
KW - prosthetic joint infection
KW - total shoulder replacement
KW - total elbow replacement
KW - meta-analysis
U2 - 10.1016/j.jinf.2020.01.008
DO - 10.1016/j.jinf.2020.01.008
M3 - Article (Academic Journal)
C2 - 31981635
SN - 0163-4453
VL - 80
SP - 426
EP - 436
JO - Journal of Infection
JF - Journal of Infection
IS - 4
ER -