Centre de recherche Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Que.
Can J Surg. 2012 Dec;55(6):394-400. doi: 10.1503/cjs.033610.
Periprosthetic joint infections (PJIs) are major complications associated with high costs and substantial morbidity. We sought to evaluate hip and knee arthroplasty infection rates at our hospital, compare them in periods before and after implementation of measures to reduce PJIs (1990-2002 and 2003-2007) and identify associated risk factors.
We retrospectively reviewed records of patients who received primary hip or knee total joint prostheses at our centre between Jan. 1, 1990, and Dec. 31, 2007, and were readmitted for the treatment of infection related to their surgery. We also reviewed data from a prospective surveillance protocol of total hip (THA) and knee arthroplasty (TKA) infections that started in November 2005. We ascertained the annual rates of deep, superficial and hematogenous infections.
During the periods studied, 2403 THAs and 1220 TKAs were performed. For THA, the average rates of deep, superficial and hematogenous infections were 2.0%, 0.8% and 0.3%, respectively. For TKA, the rates were 1.6%, 0.7% and 0.2%, respectively. Of 106 infected joints, 84 (79.2%) presented risk factors for infection. Efforts to reduce the infection rate at our institution began in 2003. We achieved a 44% decrease in the deep infection rate for THA (2.5% v. 1.4%; p = 0.06) and a 45% decrease for TKA (2.0% v. 1.1%, p = 0.20) between the periods studied.
Knowing the actual infection rate associated with different procedures in specific settings is essential to identify unexpected problems and seek solutions to improve patient care. Although we do not know what specific improvements were successful, we were able to decrease our infection rates to levels comparable to those reported by similar care centres.
假体周围关节感染（PJI）是与高成本和大量发病率相关的主要并发症。我们试图评估我院髋关节和膝关节置换感染率，比较实施降低 PJI 措施前后（1990-2002 年和 2003-2007 年）的感染率，并确定相关的危险因素。
我们回顾性分析了我院 1990 年 1 月 1 日至 2007 年 12 月 31 日期间接受初次髋关节或膝关节全关节置换术的患者记录，这些患者因手术相关感染而再次入院治疗。我们还回顾了 2005 年 11 月开始的全髋关节置换术（THA）和膝关节置换术（TKA）感染的前瞻性监测方案的数据。我们确定了深部、浅部和血源性感染的年发生率。
在研究期间，进行了 2403 例 THA 和 1220 例 TKA。THA 的深部、浅部和血源性感染的平均发生率分别为 2.0%、0.8%和 0.3%。TKA 的发生率分别为 1.6%、0.7%和 0.2%。106 个感染关节中，84 个（79.2%）存在感染危险因素。我们医院降低感染率的努力始于 2003 年。我们使 THA 的深部感染率降低了 44%（2.5%比 1.4%；p=0.06），TKA 的深部感染率降低了 45%（2.0%比 1.1%，p=0.20）。
了解特定环境下不同手术相关的实际感染率对于发现意外问题并寻求提高患者护理的解决方案至关重要。尽管我们不知道哪些具体改进是成功的，但我们能够将感染率降低到与类似护理中心报告的水平相当。
