Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address for J. Parvizi:
J Bone Joint Surg Am. 2013 Dec 18;95(24):2177-84. doi: 10.2106/JBJS.L.00789.
Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.
Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety days, one year, two years, and five years after surgery was assessed. Multivariate analysis was used to assess periprosthetic joint infection as an independent predictor of mortality. In the periprosthetic joint infection population, variables investigated as potential risk factors for mortality were evaluated.
Mortality was significantly greater (p < 0.001) in patients with periprosthetic joint infection compared with those undergoing aseptic revision arthroplasty at ninety days (3.7% versus 0.8%), one year (10.6% versus 2.0%), two years (13.6% versus 3.9%), and five years (25.9% versus 12.9%). After controlling for age, sex, ethnicity, number of procedures, involved joint, body mass index, and Charlson Comorbidity Index, revision arthroplasty for periprosthetic joint infection was associated with a fivefold increase in mortality compared with revision arthroplasty for aseptic failures. In the periprosthetic joint infection population, independent predictors of mortality included increasing age, higher Charlson Comorbidity Index, history of stroke, polymicrobial infections, and cardiac disease.
Although it is well known that periprosthetic joint infection is a devastating complication that severely limits joint function and is consistently difficult to eradicate, surgeons must also be cognizant of the systemic impact of periprosthetic joint infection and its major influence on fatal outcome in patients.
假体周围关节感染仍然可能使原本成功的关节置换复杂化。这种感染的治疗通常需要多次手术，从而增加了并发症和发病率。本研究探讨了假体周围关节感染与死亡率之间的关系，并旨在确定假体周围关节感染对死亡率的影响以及假体周围关节感染患者死亡的预测因素。
将 436 例至少因确诊的假体周围关节感染而接受过一次手术干预的患者与 2342 例因无菌性失败而接受翻修关节置换术的患者进行比较。评估手术后 30 天、90 天、1 年、2 年和 5 年的死亡率。使用多变量分析评估假体周围关节感染作为死亡率的独立预测因素。在假体周围关节感染人群中，评估了作为死亡潜在危险因素的变量。
与无菌性翻修关节置换术相比，假体周围关节感染患者的死亡率显著更高（p<0.001），90 天时为 3.7%比 0.8%，1 年时为 10.6%比 2.0%，2 年时为 13.6%比 3.9%，5 年时为 25.9%比 12.9%。在控制年龄、性别、种族、手术次数、受累关节、体重指数和 Charlson 合并症指数后，与无菌性翻修关节置换术相比，假体周围关节感染的翻修与死亡率增加 5 倍相关。在假体周围关节感染人群中，死亡率的独立预测因素包括年龄增加、Charlson 合并症指数升高、中风史、多微生物感染和心脏病。
尽管假体周围关节感染是一种严重限制关节功能且难以根除的破坏性并发症已广为人知，但外科医生还必须认识到假体周围关节感染的全身影响及其对患者致命结局的重大影响。
