Risk Factors for Recurrence of Periprosthetic Joint Infection in Patients with Hemophilia

Relevance. Joint arthroplasty is a surgical method for treating deforming osteoarthritis, the use of which is increasing annually. With improved access to replacement therapy for patients with hemophilia, arthroplasty has become an effective treatment for hemophilic arthropathy. As the number of surgeries grows, the number of complications inevitably rises, one of which is periprosthetic joint infection. A significant problem is infection recurrence, which according to international data can reach 23.1%. In the case of hemophilia patients, the proportion of recurrent infections is 50%. Risk factors for recurrence of periprosthetic joint infection in patients with hemophilia require further study, which will enable the prevention of infectious complications following joint arthroplasty.

Objective. To analyze periprosthetic joint infections in patients with hemophilia and recurrences of this complication, as well as to assess the impact of various risk factors on the probability of recurrence.

Materials and Methods. A retrospective study analyzed cases of periprosthetic joint infection in patients with hemophilia who underwent surgical treatment between 2015 and 2024. Risk factors present at disease onset were identified and their influence on the likelihood of infection recurrence was evaluated.

Results. 102 surgical interventions in 47 patients were analyzed. Recurrences of periprosthetic joint infection occurred in 56.9% of cases. The overall probability of recurrence increases by the 40th month post-intervention to 64%. In hemophilia B, the probability of recurrence reaches 71% by 12 months. The age group most at risk is patients with onset at 60 years of age and older. A single-stage treatment protocol carries the highest chance of recurrence. The affected joint, antibiotic resistance of the pathogen, and markers of viral hepatitis did not have a significant influence. Intraoperative blood loss of less than 400 ml increases the risk of infection recurrence. Revision status of the prosthesis increases the probability of recurrence by 2.86 times. Polymicrobial infection has higher chances of recurrence.

Conclusions. Significant correlations were found between certain risk factors: specifically, hemophilia B and a single-stage treatment protocol with prosthesis retention increase the risk of recurrence. Prosthesis status, the number of pathogens, and patient age increase the likelihood of recurrence, which aligns with global literature data. Intraoperative blood loss is likely a non-relevant factor, as it does not account for total blood loss.

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