Prior Nonshoulder Periprosthetic Joint Infection Increases the Risk of Surgical Site Infection, Sepsis, and All-Cause Revision After Primary Total Shoulder Arthroplasty
Bibliographic record
Abstract
INTRODUCTION: Periprosthetic joint infection (PJI) after total joint arthroplasty is a known risk factor for infection in subsequent joint arthroplasty. The purpose of this study was to determine whether prior nonshoulder PJI contributes to the increased risk of infectious complications, greater healthcare utilization, and increased revision surgery after primary total shoulder arthroplasty (TSA). METHODS: Patients who underwent primary TSA for osteoarthritis with prior nonshoulder PJI were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were propensity matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index >30 kg/m2) to a control cohort of patients who underwent primary TSA for osteoarthritis without any prior PJI. Primary outcomes include 1- and 2-year revision rates. Secondary outcomes include healthcare-specific outcomes of readmission, emergency department visits, length of stay, and mortality. Bivariate analysis was conducted using chi-square tests to compare all outcomes and complications between both cohorts. RESULTS: Compared with patients without prior PJI, those with prior PJI had a significantly higher risk of 90-day surgical site infection (7.61% versus 0.56%) and sepsis (1.79% versus 0.56%) after TSA (P < 0.05 for both). Patients with prior PJI also had a higher risk of 90-day readmission compared with those without prior PJI (3.36% versus 1.23%, P = 0.008). In terms of surgical complications, patients with prior PJI had significantly higher risk of 2-year revision surgery compared with patients without prior PJI (3.36% versus 1.57%, P = 0.034). CONCLUSION: Prior nonshoulder PJI of any joint increases rates of 90-day surgical site infection, sepsis, and hospital readmission, as well as 2-year all-cause revision after TSA. These results are important for risk-stratifying patients undergoing TSA with prior history of PJI. LEVEL OF EVIDENCE: III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".