| Abstract / Summary | This dissertation examines the risk of PJI after knee arthroplasty, focusing on temporal trends, validation and use of PJI in national registry data, and the influence of patient-related, clinical, and socioeconomic factors on PJI revision risk. The research is presented through four key studies, each contributing valuable insights into the prevention, detection, and management of PJI.
Study I investigated the temporal trends in PJI revision incidence after knee arthroplasty using data from the Danish Knee Arthroplasty Registry (DKR) from 1997 through 2019. The results revealed a five-fold increase in PJI revision incidence within the first 3 months after primary surgery. The observed increase may be attributed to shifts in diagnostic practices, changes in patient demographics, variations in pathogen characteristics, and improvements in PJI detection within the DKR. Key risk factors for PJI revision included male sex, older age, and extreme obesity. Furthermore, partial knee arthroplasty was associated with a lower risk of PJI revision compared to total knee arthroplasty (TKA).
Study II validated PJI registrations in the DKR by comparing them with the HAIBA algorithm, which incorporates microbiology data. The sensitivity was 58%, increasing to 64% when accounting for potential misclassifications. Most missed PJI cases were due to non-reporting rather than misclassification in the DKR. The combination of the DKR and HAIBA led a novel method that successfully captured both missed PJI cases "below the surface" of the DKR and culture-negative cases not identified by the HAIBA algorithm. This method demonstrates that integrating microbiological data into national arthroplasty registries significantly improves PJI detection, addressing previous limitations of underreporting and enhancing the overall validity of PJI reporting.
Study III examined the clinical profiles of TKA patients with and without diabetes and revealed that TKA patients with diabetes had poorer health and socioeconomic positions compared to those without diabetes. The study also found significant variation in the risk of PJI among diabetic patients and presented this variation in a clinically useful risk assessment chart. These findings underscored the need for individualized preoperative risk assessments, moving beyond a "one-size-fits-all" approach for patients with diabetes.
Study IV examined the socioeconomic inequality in PJI revision risk and identified that patients with low income and those living alone, particularly men, have an elevated risk of PJI revision. The findings suggested that targeted interventions, such as tailored perioperative programs, may help reduce PJI risk in these subgroups.
Despite advances in knee arthroplasty implants and techniques, PJI remains a challenge, with increased early revision rates highlighting the need for continued research and improved prevention. This dissertation introduces a novel method for capturing PJI data in national arthroplasty registries by incorporating microbiology data, which is now part of the DKR annual report.
Our findings show that factors such as sex, obesity, comorbidity, diabetes, and social support influence PJI risk. Targeted interventions, including life-style preoperative counseling and personalized postoperative follow-up, could help reduce PJI revision risk in high-risk patients.
In conclusion, this work advocates for personalized preoperative assessments and the integration of microbiological data into arthroplasty registries to improve PJI detection, reduce disparities, and optimize care for high-risk TKA patients.
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| Andre oplysninger | PhD thesis: https://www.ortopaedi.dk/wp-content/uploads/2026/03/Dissertation_phd_mab.pdf
Publications included in the PhD thesis
1. Trend study (Acta Orthopaedica, 2023)
Temporal trends in revision rate due to knee periprosthetic joint infection: a study of 115,120 cases from the Danish Knee Arthroplasty Register.
Anneberg M, Troelsen A, Gundtoft P, Sørensen HT, Pedersen AB.
Acta Orthop. 2023;94:616–624.
DOI: 10.2340/17453674.2023.33294
Link: https://actaorthop.org/actao/article/view/33294
2. Validation study (Acta Orthopaedica, 2024)
Enhancing the data capture of periprosthetic joint infections in the Danish Knee Arthroplasty Registry: validity assessment and incidence estimation.
Anneberg M, Kristiansen EB, Troelsen A, Gundtoft P, Sørensen HT, Pedersen AB.
Acta Orthop. 2024;95:166–173.
DOI: 10.2340/17453674.2024.40358
Link: https://actaorthop.org/actao/article/view/40358
3. Diabetes study (Bone & Joint Journal, 2025)
Clinical profile and risk of periprosthetic joint infection after total knee arthroplasty in patients with and without diabetes.
Anneberg M, Troelsen A, Gundtoft PH, Pedersen AB.
Bone Joint J. 2025;107-B(8):813–820.
DOI: 10.1302/0301-620X.107B8.BJJ-2024-1424.R1
Link: https://boneandjoint.org.uk/Article/10.1302/0301-620X.107B8.BJJ-2024-1424.R1
4. Socioeconomic study (Acta Orthopaedica, 2025)
Association of socioeconomic inequality and risk of periprosthetic joint infection after total knee arthroplasty: a Danish cohort study of 75,141 cases.
Anneberg M, Troelsen A, Gundtoft P, Pedersen AB.
Acta Orthop. 2025;96:371–379.
DOI: 10.2340/17453674.2025.43678
Link: https://actaorthop.org/actao/article/view/43678
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