DOS Afhandlingsdatabase
| Titel på arbejdet | Mortality and Cause of Death in Patients with Periprosthetic Joint Infection following Hip and Knee Arthroplasty |
|---|---|
| Navn | Nicolai Kjældgaard Kristensen |
| Årstal | 2025 |
| Afdeling / Sted | Regionshospitalet Horsens & CPK Regionshospitalet Silkeborg |
| Universitet | Aarhus Universitet |
| Subspeciale |
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| Abstract / Summary | This dissertation examines mortality and causes of death following revision for periprosthetic joint infection (PJI) after total hip and knee arthroplasty, with a focus on microbiologically verified infections, comparable surgical control groups, and nationwide registry-based analyses. The research is presented through three key studies, each contributing to a more precise understanding of the prognosis and systemic impact of PJI. Study I investigated mortality following revision for PJI after total knee arthroplasty using a nationwide Danish cohort with microbiological confirmation. Patients undergoing revision for PJI had a 48% higher mortality risk compared to those undergoing major aseptic revision. Mortality increased substantially over time, reaching 36% at 10 years, highlighting PJI as a serious systemic condition rather than a localized complication. Study II examined mortality following revision for PJI after total hip arthroplasty in a comparable nationwide cohort. PJI was associated with a 33% increased mortality risk compared to major aseptic revisions. A pronounced rise in early postoperative mortality was observed within the first 90 days, suggesting an acute vulnerability period following infection-related revision. Study III explored cause-specific mortality in a combined cohort of hip and knee revision patients. No single dominant cause of death explained the excess mortality in PJI patients. Although infection-related deaths were more frequent, the overall pattern indicated a broader systemic vulnerability, where PJI may accelerate deterioration of chronic conditions such as cardiovascular, respiratory, and gastrointestinal diseases. Despite advances in arthroplasty surgery, PJI remains a life-threatening complication. This dissertation demonstrates that the increased mortality associated with PJI is not driven by one specific cause but is likely multifactorial, reflecting both the burden of infection and underlying patient vulnerability. In conclusion, this work emphasizes that PJI should be understood as a systemic condition with wide-ranging consequences. The findings highlight the need for comprehensive, multidisciplinary management strategies and improved risk assessment to optimize outcomes for patients undergoing revision arthroplasty. |
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