Paper of the Week: Symptomatic benign prostatic hyperplasia, a risk factor for periprosthetic joint infection in male patients

Yazdi H, Restrepo C, Foltz C, Hammad M, Chung PH, Gomella LG, Parvizi J.

J Bone Joint Surg Am. 2020 Apr 1;102(7):543-549.
doi: 10.2106/JBJS.19.00865

Summary by Marjan Wouthuyzen-Bakker MD, PhD

The retrospective study reported by Yazdi et al. evaluated whether symptomatic benign prostatic hyperplasia (BPH) is a risk factor for PJI. The authors evaluated 12,902 male patients undergoing primary or revision arthroplasty. The cohort included 305 patients (3%) with symptomatic BPH, of which 84% underwent primary surgery and 50% underwent total knee arthroplasty. Patients with symptomatic BPH had a higher rate of PJI compared to the controls (7.9% versus 2.8% respectively; P<0.001). To control for confounding variables, patients with symptomatic BPH were matched to a control group (250:708) according to age, BMI, implant characteristics, Charlson Comorbidity Index, Elixhauser Comorbidity Index, presence of a tumor, and diagnosis of osteoarthritis or rheumatoid arthritis. Within the matched cohort, the rate of PJI was again higher in the BPH group (7.2% versus 3.4%, P = 0.01) and symptomatic BPH remained an independent predictor for PJI in a multivariate analysis (OR 2.21, 95% CI 1.18 to 4.15).

The pathogenesis of the higher PJI rate in patients with symptomatic BPH remains unclear. Although one expects that this might be due to (asymptomatic) bacteriuria, which is a known risk factor for PJI [1-2], the incidence of urinary tract infection and positive urine culture results were similar in the symptomatic BPH PJI group and the control PJI group (P>0.67).  In addition, the symptomatic BPH PJI group did not have a statistically significant different proportion of acute, chronic, and/or hematogenous PJI compared to the control PJI group. Although the study reported no difference in MSSA, MRSA, streptococci or gram-negative bacteria between the BPH and control PJI groups, no absolute numbers of incidence for these infectious organisms were provided.


  1. Sousa R, Munoz-Mahamud E, Qualy J et al. Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis 2014; 59(1): 41-7.
  2. Weale R, El-Bakri F, Saeed K. Preoperative asymptomatic bacteriuria: a risk factor for prosthetic joint infection? J Hosp Infect 2019; 101(2): 210-3.

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