Severe adverse events during medical and surgical treatment of hip and knee prosthetic joint infections

•Our study underlines the high frequency of severe adverse events (SAEs) while replacing a prosthetic joint due to infection, which is estimated at 34.7%.•These SAEs are in function of the operation's complexity (due to hemorrhagic accidents) and the high frequency of comorbidity.•Associated SAE factors are joint exchange in 2 stages (Odds ratio=3.75) rather than 1 and, to a lesser degree, obesity (Odds ratio=3.36). The management of prosthetic joint infection requires a complex treatment procedure and can be associated with complications. However, the occurrence of severe adverse events during this intervention has been poorly evaluated. A 5-year multicentric retrospective study including patients from 3 hospitals in the South-Western France referral center for complex bone and joint infections (Crioac GSO) and treated for hip or knee prosthetic joint infection with 1 or 2-stage implant exchanges. The objective was to describe grade≥3 adverse events, according to the CTCAE classification, occurring within 6 weeks after surgery and to identify their associated factors. One hundred and eighteen patients were identified. We observed 71 severe events in 50 patients (42.3%; 95% confidence interval [CI95%]: 33.8-51.4%). Sixteen severe events were an evolution of the infection. The remaining 55 others (47 grade 3 and 8 grade 4) occurred in 41 patients (34.7%; CI95%: 26.8–43.7%). They were distributed as follows: 27 (49.1%) medical complications, 21 (38.2%) surgical complications and 7 (12.7%) antibiotic-related complications. The main identified risk factor was a two-stage prosthetic exchange with OR=3.6 (CI95% [1.11–11.94], P=0.032). Obesity was limit of significance with OR=3.3 (CI95% [0.9–12.51], P=0.071). Infection with coagulase negative Staphylococcus was a protective factor with OR=0.3 (CI95% [0.12–0.99], P=0.047). Severe adverse events are frequent following prosthetic exchange for PJI (34.7%) and are related to the high frequency of comorbidities in this population and to the complex surgical procedures required. The risk factor significantly associated with these events was a two-stage exchange.