Association of socioeconomic inequality and risk of periprosthetic joint infection after total knee arthroplasty: a Danish cohort study of 75,141 cases

BACKGROUND AND PURPOSE: Awareness of socioeconomic disparities in outcomes following surgical procedures is increasing. This highlights a critical challenge for clinical practice and public health. We examined whether low socioeconomic position (SEP) was associated with the incidence of revisions due to periprosthetic joint infection (PJI) following total knee arthroplasty (TKA).

METHODS: This cohort study included 75,141 patients undergoing TKA (2010-2021), identified from the Danish Knee Arthroplasty Registry (DKR). Individual-level SEP information, including wealth, living arrangements, and education, was obtained from Danish social and administrative registries. Revisions due to PJI were identified using a method combining the DKR and microbiology data. We calculated the cumulative incidence of revision due to PJI at 90 days and 2 years, and 2-year hazard ratios (aHRs) of revision due to PJI for lower vs. higher SEP groups, adjusted for age, sex, weight, and Charlson Comorbidity Index scores, with 95% confidence intervals (CI).

RESULTS: The incidence of revision due to PJI after 2 years of follow-up was 1.5% (CI 1.3-1.6) for low-wealth patients vs. 1.2% (CI 1.1-1.3) for high-wealth patients (aHR 1.3, CI 1.1-1.5); 1.5% (CI 1.3-1.7) for patients living alone vs. 1.2% (CI 1.1-1.3) for those cohabiting (aHR 1.4, CI 1.2-1.6); and 1.3% (CI 1.1-1.4) for patients with low education vs. 1.2% (CI 1.0-1.4) for those with high education (aHR 1.0, CI 0.8-1.2).

CONCLUSION: Revision due to PJI among low-wealth patients and those living alone versus the corresponding high-SEP group were associated with increased risk of revision due to PJI.