Skip to main content Accessibility help

Incidence, Secular Trends, and Outcomes of Prosthetic Joint Infection: A Population-Based Study, Olmsted County, Minnesota, 1969–2007

  • Geoffrey Tsaras (a1), Douglas R. Osmon (a1), Tad Mabry (a2), Brian Lahr (a3), Jennifer St. Sauveur (a4) (a5), Barbara Yawn (a5) (a6), Robert Kurland (a7) and Elie F. Berbari (a1)...



The epidemiology of prosthetic joint infection (PJI) in a population-based cohort has not been studied in the United States.


To provide an accurate assessment of the true incidence, secular trends, clinical manifestations, microbiology, and treatment outcomes of PJI in a population-based cohort.


Historical cohort study.


Olmsted County, Minnesota.


Residents who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) between January 1, 1969, and December 31, 2007.


Incidence rates and trends in PJI were assessed using the Kaplan-Meier method and log-rank test, as were treatment outcomes among PJI case patients.


A total of 7,375 THAs or TKAs were implanted in residents of Olmsted County during the study period. Seventy-five discrete joints in 70 individuals developed PJI, during a mean ± SD follow-up of 6.8 ± 6.1 years. The cumulative incidence of PJI was 0.5%, 0.8%, and 1.4% after 1, 5, and 10 years after arthroplasty, respectively. Overall, the rate of survival free of clinical failure after treatment of PJI was 76.8% (95% confidence interval [CI], 64.3–85.2) and 65.2% (95% CI, 33.1–76.2) at 3 and 5 years, respectively. The incidence and treatment outcomes did not significantly differ by decade of implantation, patient age at implantation, gender, or joint location.


The incidence of PJI is relatively low in a population-based cohort and is a function of age of the prosthesis. Incidence trends and outcomes have not significantly changed over the past 40 years.


Corresponding author

Department of Medicine, University of Illinois College of Medicine, 129 Phelps Avenue #508, Rockford, IL 61108 (


Hide All
1. Kurtz, S, Mowat, F, Ong, K, Chan, N, Lau, E, Halpern, M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005;87:14871497.
2. Kurtz, S, Ong, K, Lau, E, Mowat, F, Halpern, M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780785.
3. Berbari, EF, Hanssen, AD, Duffy, MC, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998;27:12471253.
4. Herbert, CK, Williams, RE, Levy, RS, Barrack, RL. Cost of treating an infected total knee replacement. Clin Orthop 1996;140145.
5. Sculpo, TP. The economic impact of infected total joint arthroplasty. Instr Course Lect 1993;42:349351.
6. Wilson, MG, Kelley, K, Thornhill, T. Infection as a complication of total knee-replacement arthroplasty: risk factors and treatment in 67 cases. J Bone Joint Surg Am 1990;72(6):878883.
7. Fitzgerald, RH Jr Nolan, DR, Ilstrup, DM, Van Scoy, RE, Washington, JA II Coventry, MB. Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 1977;59:847855.
8. Insall, J, Scott, WN, Ranawat, CS. The total condylar knee prostheses: a report of two hundred and twenty cases. J Bone Joint Surg Am 1979;61:173180.
9. Petty, W, Bryan, RS, Coventry, MB, Peterson, LF. Infection after total knee arthroplasty. Orthop Clin North Am 1989;20:201210.
10. Wymenga, AB, van Horn, JR, Theeuwes, A, Muytjens, HL, Slooff, TJ. Peri-operative factors associated with septic arthritis after arthroplasty: prospective multicenter study of 362 knee and 2651 hip operations. Acta Orthop Scand 1992;63:665671.
11. Rand, JA, Fitzgerald, RH Jr Diagnosis and management of the infected total knee arthroplasty. Orthop Clin North Am 1989;20:201210.
12. Bengston, S, Knutson, K. The infected knee arthroplasty: a 6-year follow up of 357 cases. Acta Orthop Scand 1991;62:301311.
13. Melton, LJ. History of the Rochester Epidemiology Project. Mayo Clin Proc 1996;71:266274.
14. US Census Bureau. Olmsted County QuickFacts. Accessed December 13, 2008.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed