Paper of the Week: Rates and Outcomes of Periprosthetic Joint Infection in Persons Who Inject Drugs

Paper of the Week: Rates and Outcomes of Periprosthetic Joint Infection in Persons Who Inject Drugs

ICM Philly October 18, 2022

Tyler J Humphrey, BA; Alexander M Tatara, MD, PhD; Hany S Bedair, MD; Kyle Alpaugh, MD; Christopher M Melnic, MD; Sandra B Nelson, MD

Summary by Nicholas F. Cozzarelli

The opioid epidemic has been a significant problem in the United States, and the impact
of the COVID-19 Pandemic has worsened the situation [1,2] . With this growing misuse of
opioids, the amount of people who use injection forms of drugs has also increased.
Consequently, orthopaedic surgeons must be aware of the risk of intravenous drug use for total
joint arthroplasty (TJA).

Humphrey et al. performed a single-institution, retrospective, matched-cohort study to
better characterize rates and outcomes of periprosthetic joint infection (PJI) in people who inject
drugs (PWID) and to compare these to people who do not inject drugs in total hip arthroplasty
(THA) and total knee arthroplasty (TKA). 290 primary TJA patients from 2000 to 2020 were
included in this study, with 58 TJA patients with a history of intravenous drug use being matched
1:4 to 232 TJA patients without a history of intravenous (IV) drug use. The matching adjusting
for age, body mass index, gender, joint (hip or knee) and TJA indication.

The main findings of the study by Humphrey et al. demonstrated that the risk of PJI in
PWID was 9 fold greater and the risk of treatment failure was also higher in comparison to the
matched cohort of the people who do not use IV drugs. It is well-known that drug abuse is a
significant preoperative risk factor for PJI following TJA and as a result it also is a strong risk
factor for revision [3,4] . However, the findings of this study utilize a larger sample size relative
to prior studies and help to add data to the variability in the existing literature. Despite the
limitations of being a retrospective study and that there were differences in how PJI was
diagnosed over the course of the study, these findings bring attention to an important topic given
the growing opioid crisis we are in currently.

Ultimately, this study found that IV drug is a significant risk factor for PJI following TJA
and a risk factor for treatment failure of PJI following TJA, while also stressing the need to have
additional studies on multidisciplinary programs for TJA outcomes in people with IV substance
use disorder.


  1. Trasolini NA, McKnight BM, Dorr LD. The Opioid Crisis and the Orthopedic Surgeon. J Arthroplasty 2018;33:3379-3382.e1.
  2. Slater RR, Beverley L. The Opioid Epidemic in America: Pandemic Impacts. J Am Acad Orthop Surg 2022;30:e1302–10.
  3. Tan TL, Maltenfort MG, Chen AF, Shahi A, Higuera CA, Siqueira M, et al. Development and Evaluation of a Preoperative Risk Calculator for Periprosthetic Joint Infection Following Total Joint Arthroplasty. J Bone Joint Surg Am 2018;100:777–85.
  4. Bauer DE, Hingsammer A, Ernstbrunner L, Aichmair A, Rosskopf AB, Eckers F, et al. Total knee arthroplasty in patients with a history of illicit intravenous drug abuse. Int Orthop 2018;42:101-7.
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