Abstract / Summary
Abstract Objective Revision arthroplasty procedures are associated with increased in-hospital morbidity and mortality. This study aimed to characterise in-hospital death after revision hip and knee arthroplasty, with particular focus on periprosthetic joint infection (PJI) as the leading indication among decedents. Methods In this single-centre retrospective cohort study, all patients who died in hospital after revision hip or knee arthroplasty between 2014 and 2024 were identified among 2495 patients with revision surgery coded as OPS 5-821* and 5-823*. Primary procedures and patients younger than 18 years were excluded. Clinical and microbiological data of these 103 decedents were reviewed to characterise the circumstances, timing and causes of in-hospital death, including ICU admission, septic shock, and reoperation. Clinical characteristics, causes of death, and treatment strategies were described according to revision indication for periprosthetic joint infection (PJI), periprosthetic fracture (PF), and other indications. Results Of 2495 patients undergoing revision surgery over the study period, 103 patients (4.1%) died in hospital. Decedents were predominantly elderly, with a median age of 80 years (IQR 70–85) and a higher proportion of women (58.3%) than men (41.7%). PJI was the indication for revision in the majority of decedents ( n = 78/103, 75.7%), and sepsis was the leading cause of death overall ( n = 69/103, 67.0%) and among patients with PJI ( n = 64/78, 82.1%). Patients with PJI had elevated CRP-level, with median value of 260.0 mg/l (IQR 148.5-339.3) and nearly half showed polymicrobial joint infection ( n = 36/78, 46.2%). Conclusion PJI was the leading indication among patients who died in hospital after revision arthroplasty. Positive blood cultures, elevated preoperative CRP, and polymicrobial infection characterised this cohort of fatal cases and may reflect greater disease severity, although this descriptive analysis cannot establish them as independent risk factors. Comparative studies including surviving patients are needed to confirm which characteristics independently predict adverse outcomes and to inform perioperative risk stratification and surgical decision-making.