Abstract

Background: Joint arthroplasty failure is primarily caused by Periprosthetic Joint Infection (PJI). PJI treatment may result in serious complications, such as Vertebral Osteomyelitis (VO). Risk factors for the development of metachronous VO after PJI, and the outcomes of these patients, are unknown. We aimed to 1) Identify the risk factors for developing meta-chronous VO following PJI and 2) Investigate the clinical outcomes of meta-chronous VO following PJI.

Methods: We included patients with PJI who underwent surgical intervention at our institute between January 2006 and December 2020. Patients with synchronous VO following PJI were excluded from the study. Patients with meta-chronous VO after PJI were identified and monitored during a minimum follow-up period of 5 years and we analyzed their comorbidities, procedures, causative pathogens, and clinical outcomes.

Results: We identified 567 patients with PJI, of whom seven developed VO (1.2%). We identified the following risk factors for metachronous VO after PJI: Systemic Inflammatory Response Syndrome (SIRS), drug abuse, polymicrobial infection, and 3-stage resection arthroplasty or more (Odds Ratios (ORs): 1.43, 52.98, 55.83, and 29.78, respectively). All patients who developed VO had poor clinical outcomes: two out of seven patients suffered from recurrent VO and six out of seven patients suffered from recurrent PJIs.

Conclusion: Patients with PJI who have risk factors that we identified may be predisposed to metachronous VO and likely to experience poor outcomes. We suspect that bacteremia may play a role in the pathogenesis of VO following PJI, but further research is required.

Keywords: Periprosthetic joint infection; Meta-chronous vertebral osteomyelitis; Systemic inflammatory response syndrome; Staged resection arthroplasty