Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: A systematic review and meta-analysis

Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: A systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: A systematic review and meta-analysis Chang-Rack Lee, Dae-Hyun Park, Yong-Uk Kwon, Ji-Hun Park, Dong-Yun Lee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8996570/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Whether a history of native hip or knee septic arthritis is associated with an increased risk of periprosthetic joint infection (PJI), aseptic revision, or reoperation after total joint arthroplasty (TJA) remains unclear. This meta-analysis aimed to evaluate whether patients with a history of native hip or knee septic arthritis (septic arthritis group) are at higher risk of PJI, aseptic revision, and reoperation after primary TJA than those without (nonseptic arthritis group). We hypothesized that a history of septic arthritis is associated with an increased risk of complications after TJA. Methods A systematic literature search of MEDLINE, Embase, and the Cochrane Library was conducted to identify studies comparing the outcomes of primary TJA between patients with a history of native hip or knee septic arthritis and those without. Previous studies reporting postoperative infection, aseptic revision, or reoperation rates were included in the analysis. The septic arthritis group comprised patients with sequelae of childhood joint infection and those who underwent one- or two-stage TJA for active or previously treated septic arthritis. Random-effects meta-analyses were performed to calculate pooled risk ratios with 95% confidence intervals. Results This research included seven studies, comprising 5,842 arthroplasties in the septic arthritis group (THA: 1,351; TKA: 4,491) and 10,589 arthroplasties in the nonseptic arthritis group (THA: 5,299; TKA: 5,290). Patients with a history of septic arthritis were at significantly higher risk of postoperative PJI than those without, with substantial heterogeneity. The risk of aseptic revision did not significantly differ between the septic arthritis and nonseptic arthritis groups. However, patients with a history of septic arthritis were at significantly higher risk of reoperation. Conclusions Patients with a history of native hip or knee septic arthritis are at significantly higher risk of postoperative infection and reoperation after total joint arthroplasty compared with those without a history of joint infection. Surgeons should be aware of the increased risk of complications in this high-risk population. Nevertheless, further studies should be performed to determine the optimal timing of arthroplasty after septic arthritis and to identify strategies that can reduce postoperative complications. Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Septic arthritis is an orthopedic emergency that requires prompt diagnosis and management, as delays in diagnosis or treatment can lead to extensive joint destruction [ 1 ]. The knee joint is the most commonly affected joint, accounting for approximately 50%–60% of all septic arthritis cases. With the increase in older population and the growing number of patients with diabetes or immunocompromised conditions, the incidence of septic arthritis has risen [ 2 , 3 ]. In addition, septic arthritis is considered a relatively common and important condition in pediatric orthopedics [ 4 ]. The fundamental principles of treating septic arthritis include comprehensive removal of infected tissues combined with appropriate antibiotic therapy. In knee or hip joint infection, various surgical treatment options, including open synovectomy and arthroscopic management, have been proposed for the resection of infected tissues. Despite appropriate antibiotic therapy and surgical treatment, some patients with septic arthritis subsequently develop degenerative arthritis and require total joint arthroplasty (TJA). Further, in cases of knee or hip joint infection accompanied by advanced arthritis, two-stage TJA using an antibiotic-impregnated articulating or static cement spacer is occasionally performed [ 5 – 7 ]. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatment options for patients with end-stage arthritis of the knee or hip joint, with a long-term survivorship of > 90% [ 8 ]. However, several studies have reported that patients with a history of native knee or hip septic arthritis have a higher rate of complications, including periprosthetic joint infection (PJI), after TKA or THA than those without [ 9 , 10 ]. Nevertheless, studies specifically addressing native knee or hip septic arthritis preceding TJA remain limited. Therefore, it is important to compare the outcomes of TJA between patients with a history of native knee or hip septic arthritis and those without. This meta-analysis aimed to evaluate whether patients with a history of native knee or hip septic arthritis are at higher risk of postoperative infection, aseptic revision, and reoperation after TJA compared with those without. We hypothesized that patients with a history of native knee or hip septic arthritis are at higher risk of complications after TJA. Methods Literature search and information sources This study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and was based on the Cochrane review methods. A literature search was performed using the databases most commonly used in the medical field, including PubMed, EMBASE, and the Cochrane Library, from the date of inception to November 7, 2025. An information retrieval expert (medical librarian) conducted a structured search of research data based on our methodology. Appendix Table 1 presents the search protocol. After the initial database search, the reference lists of relevant articles were manually reviewed to identify additional eligible studies. Restrictions in terms of language or year of publication were not applied during the literature search. As this study conducted a systematic review of previously published literature, approval from an institutional review board and informed consent were not required. Table 1 Study characteristics Study Study design Arthroplasty Follow-up (mean) Age at surgery (mean) Septic arthritis group, n Non-septic arthritis group, n Diagnosis in non-septic arthritis group Surgical method in septic arthritis group NOS Bettencourt 2021 [ 9 ] Case–control TKA 9y Septic: 62.9y Non-septic: 63.9y 215 215 OA One-stage TKA: 175 Two-stage TKA: 40 8 Bettencourt 2022 [ 10 ] Case–control THA 11y Septic: 57.8y Non-septic: 58.8y 256 256 OA One-stage THA: 174 Two-stage THA: 82 8 Dubin 2023 [ 13 ] Retrospective cohort THA 2y Septic: 60y Non-septic: 65y 1052 5000 N/A N/A 7 Hameed 2023 [ 16 ] Retrospective cohort TKA 2y 63–66y 4251 5000 N/A N/A 7 Kwon 2025 [ 17 ] Retrospective cohort TKA Septic: 45.1m Non-septic: 45.8m Septic: 73.3y Non-septic: 73.2y 25 75 OA Two-stage TKA: 25 8 Park 2020 [ 15 ] Retrospective cohort THA 12.3y Septic: 41.2y Non-septic: 38.7y 25 25 DDH THA with subtrochanteric shortening osteotomy: 25 7 Papanna 2018 [ 14 ] Case–control THA Septic: 70m Non-Septic: 72m Septic: 58y Non-septic: 57y 18 18 OA One-stage THA: 7 Two-stage THA: 11 6 DDH, developmental dysplasia of the hip; NOS, Newcastle-Ottawa scale; OA, osteoarthritis; THA, total hip arthroplasty; TKA, total knee arthroplasty Study selection This meta-analysis included case-control or cohort studies comparing the risk of postoperative infection, aseptic revision, or reoperation after primary TJA between patients with a history of native knee or hip septic arthritis (septic arthritis group) and those without (nonseptic arthritis group). The septic arthritis group included patients who underwent TJA for arthritic changes caused by sequelae of childhood joint infection and those who underwent one- or two-stage TJA for active or previously treated septic arthritis. Infection was defined as deep infection or PJI. Aseptic revision was defined as any revision procedure involving component exchange performed for noninfectious causes, including mechanical loosening, instability, wear, and periprosthetic fracture. Studies about revision procedures performed for PJI were excluded from the analysis. Reoperation was defined as any subsequent surgical procedure performed on the index joint after the primary arthroplasty, irrespective of the underlying indication. Both infection-related and aseptic procedures were included in this study. Studies that did not distinguish wound problems or superficial infection from deep infection or PJI when evaluating infection rates after primary TKA; those that reported the outcomes of TJA only in the septic arthritis group, without comparison to a nonseptic arthritis group (case series); and those that focused on partial replacement arthroplasty were excluded from the analysis. Assessment of methodological quality Two reviewers independently assessed the methodological quality of the selected studies using the Newcastle–Ottawa Scale, a tool designed to assess the methodological quality of non-randomized studies in systematic reviews and/or meta-analyses. Further, it comprises three domains: selection of the study groups, comparability of the groups, and ascertainment of either the exposure or outcomes of interest for case-control or cohort studies. The maximum score is 9, and studies with scores of ≥ 7 were considered to be of high methodological quality [ 4 , 11 ]. Any disagreements between reviewers were resolved via a consensus decision. If a consensus could not be reached, discrepancies were resolved via a discussion with a third investigator. Data extraction Two reviewers independently extracted data from the included studies using a predefined data extraction form. The following information was collected: first author, year of publication, sample size, mean age at the time of surgery, mean follow-up duration, type of TJA (one- or two-stage surgery) in the septic arthritis group, and postoperative outcomes, including infection, aseptic revision, and reoperation. Statistical analysis To evaluate the risk of postoperative complications in the septic arthritis and nonseptic arthritis groups, data on sample size and the number of cases of postoperative infection, aseptic revision, and reoperation in each group were extracted from each study that was included in this meta-analysis. Meta-analyses were performed using a random-effects model, and risk ratios with 95% confidence intervals were calculated. The meta-analysis was conducted for the following outcomes: (1) risk of PJI, (2) risk of aseptic revision, and (3) risk of reoperation. Statistical heterogeneity among studies was assessed using the I² statistic, with I² values of 25%, 50%, and 75% representing low, moderate, and high heterogeneity, respectively. Forest plots were used to present the results of individual studies, pooled estimates of effect, and overall summary effects. Considering the suggested inefficiency of funnel plots for assessing publication bias in the meta-analyses of proportion studies with low event rates, as previously reported, publication bias was not formally assessed [ 12 ]. Statistical significance was set at a p value of < 0.05. All analyses were performed using Review Manager version 5.3 (Copenhagen, the Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Results Study selection Figure 1 shows the study selection process. The literature search identified 2,585 records, including 1,233 from PubMed (MEDLINE), 1,316 from EMBASE, and 36 from the Cochrane Library. No additional relevant studies were identified via manual searching of reference lists. After removing 368 duplicate records, 2,217 studies remained for title and abstract screening, of which 2,196 were excluded. The remaining 21 studies underwent full-text review. Ultimately, seven studies were included in this systematic review and meta-analysis. Characteristics of the study and risk-of-bias assessment Across the seven included studies, the septic arthritis group comprised 5,842 cases (THA: 1,351; TKA: 4,491), and the nonseptic arthritis group included 10,589 cases (THA: 5,299; TKA: 5,290). The mean follow-up duration after TJA in the included studies ranged from 45.1 months to 12.3 years. The mean age of the patients who underwent THA ranged from 38.7 to 58 years. Meanwhile, the mean age of the patients who underwent TKA ranged from 63 to 73.2 years. Five studies reported the causative organisms of native septic arthritis, with Staphylococcus aureus being the most commonly identified pathogen. Four studies evaluated the outcomes of THA between the septic arthritis group and the nonseptic arthritis group [ 10 , 13 – 15 ]. One study compared the outcomes of THA between patients with hip dislocation secondary to childhood septic arthritis and those with Crowe type IV developmental dysplasia of the hip [ 15 ]. The remaining two studies compared the outcomes of THA between patients with a history of septic hip arthritis and those with hip osteoarthritis [ 10 , 14 ]. In addition, one study did not report the underlying diagnosis leading to THA [ 13 ]. Three studies described the surgical method for THA performed on the septic arthritis group (n = 299). In these studies, 206 and 93 patients underwent one- and two-stage THA, respectively [ 10 , 14 , 15 ]. Three studies evaluated the outcomes of TKA between the septic arthritis and nonseptic arthritis groups [ 9 , 16 , 17 ]. Two studies compared patients with a history of septic knee arthritis and those with knee osteoarthritis [ 9 , 17 ]. Meanwhile, one study did not report the underlying diagnosis leading to TKA in the nonseptic arthritis group [ 16 ]. Two studies described the surgical method for TKA performed on the septic arthritis group (n = 290). In these studies, 175 and 115 patients underwent one- and two-stage TKA, respectively [ 9 , 17 ]. Table 1 presents the characteristics of the included studies and the risk-of-bias assessment performed using the Newcastle–Ottawa Scale criteria. Comparison of PJI, aseptic revision, and reoperation between the septic arthritis and nonseptic arthritis groups In total, seven studies were included in the analysis of PJI. Overall, patients with a history of septic arthritis had a significantly higher risk of postoperative PJI than those without (risk ratio [RR] = 7.01, 95% confidence interval [CI]: 1.63–30.06, p = 0.009), with substantial heterogeneity among studies (I² = 94%). In the subgroup analysis, the septic arthritis group was at significantly higher risk of PJI after TKA than the nonseptic arthritis group (RR = 16.4, 95% CI: 3.64–74.17, p = 0.0003, I² = 79%). In contrast, although patients with a history of septic arthritis undergoing THA exhibited a trend toward an increased risk of PJI, this difference did not reach statistical significance (RR = 3.56, 95% CI: 1.01–12.53, p = 0.05, I² = 58%). This analysis included five studies reporting aseptic revision. There was no significant difference in the overall risk of aseptic revision between the septic arthritis and nonseptic arthritis groups (RR = 1.11, 95% CI: 0.31–3.99, p = 0.88, I² = 87%). Based on the subgroup analysis, the risk of aseptic revision did not significantly differ between the TKA and THA subgroups. Five studies were included in the analysis of reoperation. Patients with a history of septic arthritis were at significantly higher risk of reoperation than those without (RR = 4.52, 95% CI: 1.12–18.21, p = 0.03), with considerable heterogeneity (I² = 96%). In a subgroup analysis, a significantly increased risk of reoperation was observed after TKA (RR = 7.50, 95% CI, 1.34–42.06, p = 0.02, I² = 98%). Meanwhile, there was no statistically significant increase observed after THA (RR = 1.75, 95% CI: 0.20–15.50, p = 0.62, I² = 50%). Discussion The principal finding of this study is that patients with a history of native hip or knee septic arthritis were at higher risk of postoperative infection and reoperation after TJA compared with those without. Septic arthritis can lead to the destruction of articular cartilage and subsequent functional impairment if diagnosis or treatment is delayed [ 1 ]. Open or arthroscopic debridement is commonly performed for managing septic arthritis. However, as a sequela of septic arthritis, progressive degenerative changes may develop over time. Hence, TJA is ultimately required. In addition, with the increasing proportion of older adults and immunocompromised patients, the incidence of septic arthritis occurring in joints with preexisting advanced arthritis has been increasing [ 2 , 3 ]. In such cases of infected arthritic knees or hips, two-stage TJA using an antibiotic-impregnated articulating or static cement spacer has also been performed [ 5 – 7 ]. Regardless of the timing of native joint infection, patients with a history of septic arthritis who underwent TJA may exhibit outcomes that differ from those of patients without such as history, particularly with respect to the risk of postoperative complications, such as infection. The most consistent finding of this meta-analysis was that patients with a history of septic arthritis were at increased risk of PJI after TJA. This association was observed across most included studies and was evident after TKA, with a substantially higher relative risk reported. Bettencourt et al.[ 9 ] revealed a significantly increased risk of infection after TKA performed on knees with a previous history of septic arthritis. Further, their study showed that this elevated risk was more likely attributed to alterations in the local joint environment rather than to systemic factors. The pathophysiology of implant-associated infection has revealed that bacteria can persist in a dormant state or within biofilms even if infection appears clinically resolved, and that prosthesis implantation may promote the reactivation of these residual microorganisms [ 18 , 19 ]. In addition, several studies have reported that the local joint environment may remain altered for prolonged periods after septic arthritis. Shirtliff and Mader [ 20 ] found persistent inflammatory activity and altered immune responses within synovial and intra-articular tissues even after apparent resolution of infection. Meanwhile, Masters et al.[ 21 ] showed that long-term changes in host–pathogen interactions after osteoarticular infection may adversely affect the joint microenvironment. Taken together, multiple factors—including residual bacteria and dormant biofilms within periarticular tissues, sustained alterations in local immune responses. Further, structural damage to the soft tissues and bone—may contribute to an increased risk of PJI after prosthetic implantation. Accordingly, joints with a previous history of septic arthritis should be considered as biologically distinct from joints undergoing TJA for primary degenerative conditions. A subgroup analysis showed a more pronounced increase in the risk of PJI after TKA compared with THA. These findings indicate that the observed differences in the risk of PJI may be related to joint-specific factors rather than a direct comparative effect between procedures. Joint-specific factors may include differences in local anatomy, soft-tissue coverage, vascularity, and the extent of surgical exposure, all of which can affect susceptibility to infection [ 19 , 22 , 23 ]. Nevertheless, the limited number of studies evaluating THA should be considered when interpreting these findings, as the statistical power of the THA subgroup analysis might have been insufficient. In this meta-analysis, a history of septic arthritis was not significantly associated with an increased risk of aseptic revision. Although septic arthritis increases susceptibility to postoperative infection, it may not adversely affect mechanical outcomes once infection is adequately controlled. However, the conditions that typically require aseptic revision—such as loosening, wear, instability, and periprosthetic fracture—are relatively rare events, and their accurate assessment requires long-term follow-up. This might have limited the ability of individual studies to detect minimal differences in mechanical failure rates between groups. In contrast, patients with a history of septic arthritis are at significantly higher risk of reoperation. In the included studies, reoperation encompassed a broad range of additional surgical procedures, including infection-related surgeries, irrigation, debridement, and closed reduction for dislocation under anesthesia. The aseptic revision rates did not significantly differ between patients with a history of septic arthritis and those without. However, patients with a previous history of septic arthritis more frequently underwent additional surgical procedures. This finding suggests that infection-related events and a higher risk of PJI likely played an important role in the increased rate of reoperation. This meta-analysis has several limitations. First, most of the included studies were retrospective in nature. Therefore, the influence of residual confounding factors could not be completely excluded. Second, the definitions of reoperation and aseptic revision were not completely uniform across the included studies. Database-based studies provided limited information regarding the specific types and extent of surgical procedures performed. Third, not all studies reported aseptic revision and reoperation as separate outcomes, which reduced the number of studies available for inclusion in each individual analysis. Fourth, a substantial heterogeneity was observed across analyses, likely reflecting variations in patient populations, surgical indications, and follow-up duration. Finally, the number of studies included in the THA subgroup analysis was limited. Therefore, the study results should be interpreted with caution. Despite these limitations, comparative studies evaluating complications after TJA in patients with a history of native hip or knee septic arthritis and those without remain limited. In this context, the current meta-analysis provides significant evidence regarding the association between a previous history of septic arthritis and the outcomes of TJA. Conclusion Patients with a history of native hip or knee septic arthritis are at significantly higher risk of postoperative infection and reoperation after total joint arthroplasty compared with those without a history of joint infection. Surgeons should be aware of the increased risk of complications in this high-risk population. Nevertheless, further studies should be performed to determine the optimal timing of arthroplasty after septic arthritis and to identify strategies that can reduce postoperative complications. Abbreviations CI confidence interval PJI periprosthetic joint infection RR risk ratio THA total hip arthroplasty TJA total joint arthroplasty TKA total knee arthroplasty Declarations Ethics approval and consent to participate Because this study was a systematic review of previously published literature, approval from an institutional review board and informed consent were not required. Consent for publication All authors have reviewed the manuscript and approved its submission for publication. Competing interests The authors declare that they have no competing interests Funding None Author Contribution CRL: conception and study design, manuscript writing and revision, collection of data, data analysis and interpretation. DHP: manuscript revision and review. YUK: data analysis, interpretation manuscript, review and editing. JHP: data analysis and interpretation, visualization. DYL: collection of data, data analysis and interpretation. Acknowledgement We thank Hye Won Park, Inje University Medical Library, for performing literature searches. Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Mathews, C.J., et al., Bacterial septic arthritis in adults . Lancet, 2010. 375(9717): p. 846–55. Morgan, D.S., et al., An 18 year clinical review of septic arthritis from tropical Australia . Epidemiol Infect, 1996. 117(3): p. 423–8. Nair, R., M.L. Schweizer, and N. Singh, Septic Arthritis and Prosthetic Joint Infections in Older Adults . Infect Dis Clin North Am, 2017. 31(4): p. 715–729. Lo, C.K., D. Mertz, and M. Loeb, Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments . BMC Med Res Methodol, 2014. 14: p. 45. Kunze, K.N., et al., Two-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience . Arthroplast Today, 2020. 6(3): p. 431–436. Russo, A., et al., Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes . J Clin Orthop Trauma, 2022. 24: p. 101720. Tahmasebi, M.N., et al., Two-stage Total Knee Arthroplasty for Treatment of Surgical Failure of Septic Arthritis in Degenerative Knee Joints . 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Dubin, J.A., et al., Less Than 1-Year Quiescent Period After Septic Arthritis of the Hip is Associated With High Risk of Periprosthetic Joint Infection Following Total Hip Arthroplasty . J Arthroplasty, 2023. 38(5): p. 930–934.e1. Papanna, M.C., et al., Infection and failure rates following total hip arthroplasty for septic arthritis: a case-controlled study . Hip Int, 2018. 28(1): p. 63–67. Park, C.W., et al., Total Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia . J Arthroplasty, 2020. 35(1): p. 204–211. Hameed, D., et al., Prior Septic Arthritis Within One Year of Knee Arthroplasty is Associated With a High Risk for Infection . J Arthroplasty, 2023. 38(5): p. 925–929.e1. Kwon, Y.U., et al., Outcomes of two-stage total knee arthroplasty following septic arthritis of the native knee: A propensity score-matched analysis . Knee, 2025. 57: p. 171–178. Costerton, J.W., P.S. Stewart, and E.P. Greenberg, Bacterial biofilms: a common cause of persistent infections . Science, 1999. 284(5418): p. 1318–22. Zimmerli, W., A. Trampuz, and P.E. Ochsner, Prosthetic-joint infections . N Engl J Med, 2004. 351(16): p. 1645–54. Shirtliff, M.E. and J.T. Mader, Acute septic arthritis . Clin Microbiol Rev, 2002. 15(4): p. 527–44. Masters, E.A., et al., Skeletal infections: microbial pathogenesis, immunity and clinical management . Nat Rev Microbiol, 2022. 20(7): p. 385–400. Kapadia, B.H., et al., Periprosthetic joint infection . Lancet, 2016. 387(10016): p. 386–394. Tande, A.J. and R. Patel, Prosthetic joint infection . Clin Microbiol Rev, 2014. 27(2): p. 302–45. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8996570","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602446792,"identity":"af4d1a80-7c4f-4e18-974d-753c6b89e7bd","order_by":0,"name":"Chang-Rack Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIie3RMUvDQBTA8RceJMurWV+J6GcoB4UOJl8lctApBaGjQguFdNK5Q7+Ekx2Vg3S5D9BBhFLoJHhQCLiIF1ER4VrcHO4P93jLjzs4AJ/vH3ZkD37uCAaA+GO/d5PwJwlmfyZIdh4m0eRhd3H1mN5N1UacLdLj9hjXBvSTm1Alk1m1lXPdF3KgJSUQCobV0E246CKFSjIUqAYl0glAF8DkbnL6UiO9WRI/o+qVI0uiej9hCrFVqpS5QBmUyj6M7C2rPYT6ImndqJx5KzrXekntCQ05124SR2q9o1plHMsNvy4uM15Ob42p3OSr83Ezg2Y233QYAGTwTXw+n8/3q3fmF0mCpPKOjwAAAABJRU5ErkJggg==","orcid":"","institution":"Inje University Busan Paik Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chang-Rack","middleName":"","lastName":"Lee","suffix":""},{"id":602446793,"identity":"8741dac0-69d4-4d79-81b2-c937acfdb5c1","order_by":1,"name":"Dae-Hyun Park","email":"","orcid":"","institution":"Inje University Busan Paik Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dae-Hyun","middleName":"","lastName":"Park","suffix":""},{"id":602446794,"identity":"9d7fce96-9f7d-40d2-a79f-0cb80c7c54d5","order_by":2,"name":"Yong-Uk Kwon","email":"","orcid":"","institution":"Inje University Busan Paik Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yong-Uk","middleName":"","lastName":"Kwon","suffix":""},{"id":602446795,"identity":"427a9c7b-7223-4f3b-b0cf-357ccff2a9aa","order_by":3,"name":"Ji-Hun Park","email":"","orcid":"","institution":"Inje University Busan Paik Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ji-Hun","middleName":"","lastName":"Park","suffix":""},{"id":602446796,"identity":"e7fe64e5-3357-4aa6-a6d5-15b9f9b80f78","order_by":4,"name":"Dong-Yun Lee","email":"","orcid":"","institution":"Inje University Busan Paik Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dong-Yun","middleName":"","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2026-02-28 15:39:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8996570/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8996570/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104322706,"identity":"b42396f5-63ad-4b8e-b1f6-021eb0006f3c","added_by":"auto","created_at":"2026-03-10 13:27:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":297519,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8996570/v1/1a6c0f18aa760bbd449527bc.jpg"},{"id":104322703,"identity":"92332454-21ee-494b-81a9-ddaf7cc8c916","added_by":"auto","created_at":"2026-03-10 13:27:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":262344,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot comparing the risk of periprosthetic joint infection after total joint arthroplasty in patients with and without prior septic arthritis. M-H= Mantel-Haenszel, and df=degrees of freedom.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8996570/v1/47506a83d35f1803a08b24ae.jpg"},{"id":104322700,"identity":"b88bf966-f1f6-4a78-b5c0-b1453b444e8f","added_by":"auto","created_at":"2026-03-10 13:27:02","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":279016,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot comparing the risk of aseptic revision after total joint arthroplasty in patients with and without prior septic arthritis. M-H= Mantel-Haenszel, and df=degrees of freedom.\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8996570/v1/75a4e8d96b4e4ebdd477b4f5.jpg"},{"id":104322715,"identity":"42753032-2a60-4cfd-8993-7b9808befd7e","added_by":"auto","created_at":"2026-03-10 13:27:08","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":255913,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot comparing the risk of reoperation after total joint arthroplasty in patients with and without prior septic arthritis. M-H= Mantel-Haenszel, and df=degrees of freedom.\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8996570/v1/4e63afbaf68c14fa666cd199.jpg"},{"id":104322818,"identity":"efe05bef-e941-473f-b405-48254a234fa8","added_by":"auto","created_at":"2026-03-10 13:27:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1813168,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8996570/v1/3f0271dc-a38f-4daf-96d5-f30e04b8413a.pdf"},{"id":104322683,"identity":"abc9d3ef-4a22-41c7-9857-ad624cc7e752","added_by":"auto","created_at":"2026-03-10 13:26:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20671,"visible":true,"origin":"","legend":"","description":"","filename":"PriorsepticTJAsupplementaryfiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-8996570/v1/80207cd8415686a3b377f032.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: A systematic review and meta-analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eSeptic arthritis is an orthopedic emergency that requires prompt diagnosis and management, as delays in diagnosis or treatment can lead to extensive joint destruction [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The knee joint is the most commonly affected joint, accounting for approximately 50%\u0026ndash;60% of all septic arthritis cases. With the increase in older population and the growing number of patients with diabetes or immunocompromised conditions, the incidence of septic arthritis has risen [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition, septic arthritis is considered a relatively common and important condition in pediatric orthopedics [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe fundamental principles of treating septic arthritis include comprehensive removal of infected tissues combined with appropriate antibiotic therapy. In knee or hip joint infection, various surgical treatment options, including open synovectomy and arthroscopic management, have been proposed for the resection of infected tissues. Despite appropriate antibiotic therapy and surgical treatment, some patients with septic arthritis subsequently develop degenerative arthritis and require total joint arthroplasty (TJA). Further, in cases of knee or hip joint infection accompanied by advanced arthritis, two-stage TJA using an antibiotic-impregnated articulating or static cement spacer is occasionally performed [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTotal knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatment options for patients with end-stage arthritis of the knee or hip joint, with a long-term survivorship of \u0026gt;\u0026thinsp;90% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, several studies have reported that patients with a history of native knee or hip septic arthritis have a higher rate of complications, including periprosthetic joint infection (PJI), after TKA or THA than those without [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nevertheless, studies specifically addressing native knee or hip septic arthritis preceding TJA remain limited. Therefore, it is important to compare the outcomes of TJA between patients with a history of native knee or hip septic arthritis and those without.\u003c/p\u003e \u003cp\u003eThis meta-analysis aimed to evaluate whether patients with a history of native knee or hip septic arthritis are at higher risk of postoperative infection, aseptic revision, and reoperation after TJA compared with those without. We hypothesized that patients with a history of native knee or hip septic arthritis are at higher risk of complications after TJA.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLiterature search and information sources\u003c/h2\u003e \u003cp\u003eThis study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and was based on the Cochrane review methods. A literature search was performed using the databases most commonly used in the medical field, including PubMed, EMBASE, and the Cochrane Library, from the date of inception to November 7, 2025. An information retrieval expert (medical librarian) conducted a structured search of research data based on our methodology. Appendix Table\u0026nbsp;1 presents the search protocol. After the initial database search, the reference lists of relevant articles were manually reviewed to identify additional eligible studies. Restrictions in terms of language or year of publication were not applied during the literature search. As this study conducted a systematic review of previously published literature, approval from an institutional review board and informed consent were not required.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArthroplasty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFollow-up (mean)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAge at surgery (mean)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSeptic arthritis group, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNon-septic arthritis group, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDiagnosis in non-septic arthritis group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgical method in septic arthritis group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNOS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBettencourt 2021 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u0026ndash;control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptic: 62.9y\u003c/p\u003e \u003cp\u003eNon-septic: 63.9y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOne-stage TKA: 175\u003c/p\u003e \u003cp\u003eTwo-stage TKA: 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBettencourt 2022 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u0026ndash;control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptic: 57.8y\u003c/p\u003e \u003cp\u003eNon-septic: 58.8y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOne-stage THA: 174\u003c/p\u003e \u003cp\u003eTwo-stage THA: 82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDubin 2023 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptic: 60y\u003c/p\u003e \u003cp\u003eNon-septic: 65y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHameed 2023 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63\u0026ndash;66y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwon 2025 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeptic: 45.1m\u003c/p\u003e \u003cp\u003eNon-septic: 45.8m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptic: 73.3y\u003c/p\u003e \u003cp\u003eNon-septic: 73.2y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTwo-stage TKA: 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePark 2020 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetrospective cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptic: 41.2y\u003c/p\u003e \u003cp\u003eNon-septic: 38.7y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTHA with subtrochanteric shortening osteotomy: 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePapanna 2018 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u0026ndash;control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeptic: 70m\u003c/p\u003e \u003cp\u003eNon-Septic: 72m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptic: 58y\u003c/p\u003e \u003cp\u003eNon-septic: 57y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOne-stage THA: 7\u003c/p\u003e \u003cp\u003eTwo-stage THA: 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eDDH, developmental dysplasia of the hip; NOS, Newcastle-Ottawa scale; OA, osteoarthritis; THA, total hip arthroplasty; TKA, total knee arthroplasty\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eThis meta-analysis included case-control or cohort studies comparing the risk of postoperative infection, aseptic revision, or reoperation after primary TJA between patients with a history of native knee or hip septic arthritis (septic arthritis group) and those without (nonseptic arthritis group). The septic arthritis group included patients who underwent TJA for arthritic changes caused by sequelae of childhood joint infection and those who underwent one- or two-stage TJA for active or previously treated septic arthritis.\u003c/p\u003e \u003cp\u003eInfection was defined as deep infection or PJI. Aseptic revision was defined as any revision procedure involving component exchange performed for noninfectious causes, including mechanical loosening, instability, wear, and periprosthetic fracture. Studies about revision procedures performed for PJI were excluded from the analysis. Reoperation was defined as any subsequent surgical procedure performed on the index joint after the primary arthroplasty, irrespective of the underlying indication. Both infection-related and aseptic procedures were included in this study.\u003c/p\u003e \u003cp\u003eStudies that did not distinguish wound problems or superficial infection from deep infection or PJI when evaluating infection rates after primary TKA; those that reported the outcomes of TJA only in the septic arthritis group, without comparison to a nonseptic arthritis group (case series); and those that focused on partial replacement arthroplasty were excluded from the analysis.\u003c/p\u003e\n\u003ch3\u003eAssessment of methodological quality\u003c/h3\u003e\n\u003cp\u003eTwo reviewers independently assessed the methodological quality of the selected studies using the Newcastle\u0026ndash;Ottawa Scale, a tool designed to assess the methodological quality of non-randomized studies in systematic reviews and/or meta-analyses. Further, it comprises three domains: selection of the study groups, comparability of the groups, and ascertainment of either the exposure or outcomes of interest for case-control or cohort studies. The maximum score is 9, and studies with scores of \u0026ge;\u0026thinsp;7 were considered to be of high methodological quality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Any disagreements between reviewers were resolved via a consensus decision. If a consensus could not be reached, discrepancies were resolved via a discussion with a third investigator.\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eTwo reviewers independently extracted data from the included studies using a predefined data extraction form. The following information was collected: first author, year of publication, sample size, mean age at the time of surgery, mean follow-up duration, type of TJA (one- or two-stage surgery) in the septic arthritis group, and postoperative outcomes, including infection, aseptic revision, and reoperation.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eTo evaluate the risk of postoperative complications in the septic arthritis and nonseptic arthritis groups, data on sample size and the number of cases of postoperative infection, aseptic revision, and reoperation in each group were extracted from each study that was included in this meta-analysis. Meta-analyses were performed using a random-effects model, and risk ratios with 95% confidence intervals were calculated. The meta-analysis was conducted for the following outcomes: (1) risk of PJI, (2) risk of aseptic revision, and (3) risk of reoperation.\u003c/p\u003e \u003cp\u003eStatistical heterogeneity among studies was assessed using the I\u0026sup2; statistic, with I\u0026sup2; values of 25%, 50%, and 75% representing low, moderate, and high heterogeneity, respectively. Forest plots were used to present the results of individual studies, pooled estimates of effect, and overall summary effects.\u003c/p\u003e \u003cp\u003eConsidering the suggested inefficiency of funnel plots for assessing publication bias in the meta-analyses of proportion studies with low event rates, as previously reported, publication bias was not formally assessed [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Statistical significance was set at a p value of \u0026lt;\u0026thinsp;0.05. All analyses were performed using Review Manager version 5.3 (Copenhagen, the Nordic Cochrane Centre, The Cochrane Collaboration, 2014).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy selection\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the study selection process. The literature search identified 2,585 records, including 1,233 from PubMed (MEDLINE), 1,316 from EMBASE, and 36 from the Cochrane Library. No additional relevant studies were identified via manual searching of reference lists. After removing 368 duplicate records, 2,217 studies remained for title and abstract screening, of which 2,196 were excluded. The remaining 21 studies underwent full-text review. Ultimately, seven studies were included in this systematic review and meta-analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCharacteristics of the study and risk-of-bias assessment\u003c/h3\u003e\n\u003cp\u003eAcross the seven included studies, the septic arthritis group comprised 5,842 cases (THA: 1,351; TKA: 4,491), and the nonseptic arthritis group included 10,589 cases (THA: 5,299; TKA: 5,290). The mean follow-up duration after TJA in the included studies ranged from 45.1 months to 12.3 years. The mean age of the patients who underwent THA ranged from 38.7 to 58 years. Meanwhile, the mean age of the patients who underwent TKA ranged from 63 to 73.2 years. Five studies reported the causative organisms of native septic arthritis, with \u003cem\u003eStaphylococcus aureus\u003c/em\u003e being the most commonly identified pathogen.\u003c/p\u003e \u003cp\u003eFour studies evaluated the outcomes of THA between the septic arthritis group and the nonseptic arthritis group [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. One study compared the outcomes of THA between patients with hip dislocation secondary to childhood septic arthritis and those with Crowe type IV developmental dysplasia of the hip [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The remaining two studies compared the outcomes of THA between patients with a history of septic hip arthritis and those with hip osteoarthritis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, one study did not report the underlying diagnosis leading to THA [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Three studies described the surgical method for THA performed on the septic arthritis group (n\u0026thinsp;=\u0026thinsp;299). In these studies, 206 and 93 patients underwent one- and two-stage THA, respectively [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThree studies evaluated the outcomes of TKA between the septic arthritis and nonseptic arthritis groups [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Two studies compared patients with a history of septic knee arthritis and those with knee osteoarthritis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Meanwhile, one study did not report the underlying diagnosis leading to TKA in the nonseptic arthritis group [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Two studies described the surgical method for TKA performed on the septic arthritis group (n\u0026thinsp;=\u0026thinsp;290). In these studies, 175 and 115 patients underwent one- and two-stage TKA, respectively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the characteristics of the included studies and the risk-of-bias assessment performed using the Newcastle\u0026ndash;Ottawa Scale criteria.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eComparison of PJI, aseptic revision, and reoperation between the septic arthritis and nonseptic arthritis groups\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eIn total, seven studies were included in the analysis of PJI. Overall, patients with a history of septic arthritis had a significantly higher risk of postoperative PJI than those without (risk ratio [RR]\u0026thinsp;=\u0026thinsp;7.01, 95% confidence interval [CI]: 1.63\u0026ndash;30.06, p\u0026thinsp;=\u0026thinsp;0.009), with substantial heterogeneity among studies (I\u0026sup2; = 94%). In the subgroup analysis, the septic arthritis group was at significantly higher risk of PJI after TKA than the nonseptic arthritis group (RR\u0026thinsp;=\u0026thinsp;16.4, 95% CI: 3.64\u0026ndash;74.17, p\u0026thinsp;=\u0026thinsp;0.0003, I\u0026sup2; = 79%). In contrast, although patients with a history of septic arthritis undergoing THA exhibited a trend toward an increased risk of PJI, this difference did not reach statistical significance (RR\u0026thinsp;=\u0026thinsp;3.56, 95% CI: 1.01\u0026ndash;12.53, p\u0026thinsp;=\u0026thinsp;0.05, I\u0026sup2; = 58%).\u003c/p\u003e \u003cp\u003eThis analysis included five studies reporting aseptic revision. There was no significant difference in the overall risk of aseptic revision between the septic arthritis and nonseptic arthritis groups (RR\u0026thinsp;=\u0026thinsp;1.11, 95% CI: 0.31\u0026ndash;3.99, p\u0026thinsp;=\u0026thinsp;0.88, I\u0026sup2; = 87%). Based on the subgroup analysis, the risk of aseptic revision did not significantly differ between the TKA and THA subgroups.\u003c/p\u003e \u003cp\u003eFive studies were included in the analysis of reoperation. Patients with a history of septic arthritis were at significantly higher risk of reoperation than those without (RR\u0026thinsp;=\u0026thinsp;4.52, 95% CI: 1.12\u0026ndash;18.21, p\u0026thinsp;=\u0026thinsp;0.03), with considerable heterogeneity (I\u0026sup2; = 96%). In a subgroup analysis, a significantly increased risk of reoperation was observed after TKA (RR\u0026thinsp;=\u0026thinsp;7.50, 95% CI, 1.34\u0026ndash;42.06, p\u0026thinsp;=\u0026thinsp;0.02, I\u0026sup2; = 98%). Meanwhile, there was no statistically significant increase observed after THA (RR\u0026thinsp;=\u0026thinsp;1.75, 95% CI: 0.20\u0026ndash;15.50, p\u0026thinsp;=\u0026thinsp;0.62, I\u0026sup2; = 50%).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe principal finding of this study is that patients with a history of native hip or knee septic arthritis were at higher risk of postoperative infection and reoperation after TJA compared with those without.\u003c/p\u003e \u003cp\u003eSeptic arthritis can lead to the destruction of articular cartilage and subsequent functional impairment if diagnosis or treatment is delayed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Open or arthroscopic debridement is commonly performed for managing septic arthritis. However, as a sequela of septic arthritis, progressive degenerative changes may develop over time. Hence, TJA is ultimately required. In addition, with the increasing proportion of older adults and immunocompromised patients, the incidence of septic arthritis occurring in joints with preexisting advanced arthritis has been increasing [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In such cases of infected arthritic knees or hips, two-stage TJA using an antibiotic-impregnated articulating or static cement spacer has also been performed [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Regardless of the timing of native joint infection, patients with a history of septic arthritis who underwent TJA may exhibit outcomes that differ from those of patients without such as history, particularly with respect to the risk of postoperative complications, such as infection.\u003c/p\u003e \u003cp\u003eThe most consistent finding of this meta-analysis was that patients with a history of septic arthritis were at increased risk of PJI after TJA. This association was observed across most included studies and was evident after TKA, with a substantially higher relative risk reported. Bettencourt et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] revealed a significantly increased risk of infection after TKA performed on knees with a previous history of septic arthritis. Further, their study showed that this elevated risk was more likely attributed to alterations in the local joint environment rather than to systemic factors. The pathophysiology of implant-associated infection has revealed that bacteria can persist in a dormant state or within biofilms even if infection appears clinically resolved, and that prosthesis implantation may promote the reactivation of these residual microorganisms [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, several studies have reported that the local joint environment may remain altered for prolonged periods after septic arthritis. Shirtliff and Mader [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] found persistent inflammatory activity and altered immune responses within synovial and intra-articular tissues even after apparent resolution of infection. Meanwhile, Masters et al.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] showed that long-term changes in host\u0026ndash;pathogen interactions after osteoarticular infection may adversely affect the joint microenvironment. Taken together, multiple factors\u0026mdash;including residual bacteria and dormant biofilms within periarticular tissues, sustained alterations in local immune responses. Further, structural damage to the soft tissues and bone\u0026mdash;may contribute to an increased risk of PJI after prosthetic implantation. Accordingly, joints with a previous history of septic arthritis should be considered as biologically distinct from joints undergoing TJA for primary degenerative conditions.\u003c/p\u003e \u003cp\u003eA subgroup analysis showed a more pronounced increase in the risk of PJI after TKA compared with THA. These findings indicate that the observed differences in the risk of PJI may be related to joint-specific factors rather than a direct comparative effect between procedures. Joint-specific factors may include differences in local anatomy, soft-tissue coverage, vascularity, and the extent of surgical exposure, all of which can affect susceptibility to infection [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nevertheless, the limited number of studies evaluating THA should be considered when interpreting these findings, as the statistical power of the THA subgroup analysis might have been insufficient.\u003c/p\u003e \u003cp\u003eIn this meta-analysis, a history of septic arthritis was not significantly associated with an increased risk of aseptic revision. Although septic arthritis increases susceptibility to postoperative infection, it may not adversely affect mechanical outcomes once infection is adequately controlled. However, the conditions that typically require aseptic revision\u0026mdash;such as loosening, wear, instability, and periprosthetic fracture\u0026mdash;are relatively rare events, and their accurate assessment requires long-term follow-up. This might have limited the ability of individual studies to detect minimal differences in mechanical failure rates between groups.\u003c/p\u003e \u003cp\u003eIn contrast, patients with a history of septic arthritis are at significantly higher risk of reoperation. In the included studies, reoperation encompassed a broad range of additional surgical procedures, including infection-related surgeries, irrigation, debridement, and closed reduction for dislocation under anesthesia. The aseptic revision rates did not significantly differ between patients with a history of septic arthritis and those without. However, patients with a previous history of septic arthritis more frequently underwent additional surgical procedures. This finding suggests that infection-related events and a higher risk of PJI likely played an important role in the increased rate of reoperation.\u003c/p\u003e \u003cp\u003eThis meta-analysis has several limitations. First, most of the included studies were retrospective in nature. Therefore, the influence of residual confounding factors could not be completely excluded. Second, the definitions of reoperation and aseptic revision were not completely uniform across the included studies. Database-based studies provided limited information regarding the specific types and extent of surgical procedures performed. Third, not all studies reported aseptic revision and reoperation as separate outcomes, which reduced the number of studies available for inclusion in each individual analysis. Fourth, a substantial heterogeneity was observed across analyses, likely reflecting variations in patient populations, surgical indications, and follow-up duration. Finally, the number of studies included in the THA subgroup analysis was limited. Therefore, the study results should be interpreted with caution.\u003c/p\u003e \u003cp\u003eDespite these limitations, comparative studies evaluating complications after TJA in patients with a history of native hip or knee septic arthritis and those without remain limited. In this context, the current meta-analysis provides significant evidence regarding the association between a previous history of septic arthritis and the outcomes of TJA.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePatients with a history of native hip or knee septic arthritis are at significantly higher risk of postoperative infection and reoperation after total joint arthroplasty compared with those without a history of joint infection. Surgeons should be aware of the increased risk of complications in this high-risk population. Nevertheless, further studies should be performed to determine the optimal timing of arthroplasty after septic arthritis and to identify strategies that can reduce postoperative complications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePJI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eperiprosthetic joint infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erisk ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etotal hip arthroplasty\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTJA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etotal joint arthroplasty\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTKA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etotal knee arthroplasty\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eBecause this study was a systematic review of previously published literature, approval from an institutional review board and informed consent were not required.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eAll authors have reviewed the manuscript and approved its submission for publication.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCRL: conception and study design, manuscript writing and revision, collection of data, data analysis and interpretation. DHP: manuscript revision and review. YUK: data analysis, interpretation manuscript, review and editing. JHP: data analysis and interpretation, visualization. DYL: collection of data, data analysis and interpretation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank Hye Won Park, Inje University Medical Library, for performing literature searches.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMathews, C.J., et al., \u003cem\u003eBacterial septic arthritis in adults\u003c/em\u003e. Lancet, 2010. 375(9717): p. 846\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan, D.S., et al., \u003cem\u003eAn 18 year clinical review of septic arthritis from tropical Australia\u003c/em\u003e. Epidemiol Infect, 1996. 117(3): p. 423\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNair, R., M.L. Schweizer, and N. Singh, \u003cem\u003eSeptic Arthritis and Prosthetic Joint Infections in Older Adults\u003c/em\u003e. Infect Dis Clin North Am, 2017. 31(4): p. 715\u0026ndash;729.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo, C.K., D. Mertz, and M. Loeb, \u003cem\u003eNewcastle-Ottawa Scale: comparing reviewers' to authors' assessments\u003c/em\u003e. BMC Med Res Methodol, 2014. 14: p. 45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunze, K.N., et al., \u003cem\u003eTwo-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience\u003c/em\u003e. Arthroplast Today, 2020. 6(3): p. 431\u0026ndash;436.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRusso, A., et al., \u003cem\u003eTwo-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes\u003c/em\u003e. J Clin Orthop Trauma, 2022. 24: p. 101720.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTahmasebi, M.N., et al., \u003cem\u003eTwo-stage Total Knee Arthroplasty for Treatment of Surgical Failure of Septic Arthritis in Degenerative Knee Joints\u003c/em\u003e. Arch Bone Jt Surg, 2020. 8(4): p. 524\u0026ndash;530.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang, J.S. and F.S. Haddad, \u003cem\u003eLong-term survivorship of hip and knee arthroplasty\u003c/em\u003e. Bone Joint J, 2020. 102-B(4): p. 401\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBettencourt, J.W., et al., \u003cem\u003eOutcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee: A Case-Control Study\u003c/em\u003e. J Bone Joint Surg Am, 2021. 103(18): p. 1685\u0026ndash;1693.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBettencourt, J.W., et al., \u003cem\u003eOutcomes of primary total hip arthroplasty following septic arthritis of the hip: a case-control study\u003c/em\u003e. Bone Joint J, 2022. 104-b(2): p. 227\u0026ndash;234.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStang, A., \u003cem\u003eCritical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses\u003c/em\u003e. Eur J Epidemiol, 2010. 25(9): p. 603\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunter, J.P., et al., \u003cem\u003eIn meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias\u003c/em\u003e. J Clin Epidemiol, 2014. 67(8): p. 897\u0026ndash;903.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubin, J.A., et al., \u003cem\u003eLess Than 1-Year Quiescent Period After Septic Arthritis of the Hip is Associated With High Risk of Periprosthetic Joint Infection Following Total Hip Arthroplasty\u003c/em\u003e. J Arthroplasty, 2023. 38(5): p. 930\u0026ndash;934.e1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapanna, M.C., et al., \u003cem\u003eInfection and failure rates following total hip arthroplasty for septic arthritis: a case-controlled study\u003c/em\u003e. Hip Int, 2018. 28(1): p. 63\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark, C.W., et al., \u003cem\u003eTotal Hip Arthroplasty With Subtrochanteric Shortening Osteotomy in Patients With High Hip Dislocation Secondary to Childhood Septic Arthritis: A Matched Comparative Study With Crowe IV Developmental Dysplasia\u003c/em\u003e. J Arthroplasty, 2020. 35(1): p. 204\u0026ndash;211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHameed, D., et al., \u003cem\u003ePrior Septic Arthritis Within One Year of Knee Arthroplasty is Associated With a High Risk for Infection\u003c/em\u003e. J Arthroplasty, 2023. 38(5): p. 925\u0026ndash;929.e1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKwon, Y.U., et al., \u003cem\u003eOutcomes of two-stage total knee arthroplasty following septic arthritis of the native knee: A propensity score-matched analysis\u003c/em\u003e. Knee, 2025. 57: p. 171\u0026ndash;178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosterton, J.W., P.S. Stewart, and E.P. Greenberg, \u003cem\u003eBacterial biofilms: a common cause of persistent infections\u003c/em\u003e. Science, 1999. 284(5418): p. 1318\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmerli, W., A. Trampuz, and P.E. Ochsner, \u003cem\u003eProsthetic-joint infections\u003c/em\u003e. N Engl J Med, 2004. 351(16): p. 1645\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShirtliff, M.E. and J.T. Mader, \u003cem\u003eAcute septic arthritis\u003c/em\u003e. Clin Microbiol Rev, 2002. 15(4): p. 527\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasters, E.A., et al., \u003cem\u003eSkeletal infections: microbial pathogenesis, immunity and clinical management\u003c/em\u003e. Nat Rev Microbiol, 2022. 20(7): p. 385\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapadia, B.H., et al., \u003cem\u003ePeriprosthetic joint infection\u003c/em\u003e. Lancet, 2016. 387(10016): p. 386\u0026ndash;394.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTande, A.J. and R. Patel, \u003cem\u003eProsthetic joint infection\u003c/em\u003e. Clin Microbiol Rev, 2014. 27(2): p. 302\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8996570/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8996570/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWhether a history of native hip or knee septic arthritis is associated with an increased risk of periprosthetic joint infection (PJI), aseptic revision, or reoperation after total joint arthroplasty (TJA) remains unclear. This meta-analysis aimed to evaluate whether patients with a history of native hip or knee septic arthritis (septic arthritis group) are at higher risk of PJI, aseptic revision, and reoperation after primary TJA than those without (nonseptic arthritis group). We hypothesized that a history of septic arthritis is associated with an increased risk of complications after TJA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic literature search of MEDLINE, Embase, and the Cochrane Library was conducted to identify studies comparing the outcomes of primary TJA between patients with a history of native hip or knee septic arthritis and those without. Previous studies reporting postoperative infection, aseptic revision, or reoperation rates were included in the analysis. The septic arthritis group comprised patients with sequelae of childhood joint infection and those who underwent one- or two-stage TJA for active or previously treated septic arthritis. Random-effects meta-analyses were performed to calculate pooled risk ratios with 95% confidence intervals.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThis research included seven studies, comprising 5,842 arthroplasties in the septic arthritis group (THA: 1,351; TKA: 4,491) and 10,589 arthroplasties in the nonseptic arthritis group (THA: 5,299; TKA: 5,290). Patients with a history of septic arthritis were at significantly higher risk of postoperative PJI than those without, with substantial heterogeneity. The risk of aseptic revision did not significantly differ between the septic arthritis and nonseptic arthritis groups. However, patients with a history of septic arthritis were at significantly higher risk of reoperation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePatients with a history of native hip or knee septic arthritis are at significantly higher risk of postoperative infection and reoperation after total joint arthroplasty compared with those without a history of joint infection. Surgeons should be aware of the increased risk of complications in this high-risk population. Nevertheless, further studies should be performed to determine the optimal timing of arthroplasty after septic arthritis and to identify strategies that can reduce postoperative complications.\u003c/p\u003e","manuscriptTitle":"Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: A systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 13:24:16","doi":"10.21203/rs.3.rs-8996570/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48e227f5-6b68-4dc5-8417-260e147061d0","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T13:24:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 13:24:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8996570","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8996570","identity":"rs-8996570","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}