• Kevin Clesham, Andrew J Hughes, Sven O' hEireamhoin, Catherine Fleming, and Colin G Murphy.
• Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Newcastle Road, Galway, Ireland. kevinclesham@gmail.com.
• Eur J Orthop Surg Tr. 2018 Oct 1; 28 (7): 1369-1374.

IntroductionProsthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections.MethodsOur institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay.ResultsForty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs.DiscussionHigher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.

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