Triantafyllopoulos Georgios K, Memtsoudis Stavros G, Zhang Wei, Ma Yan, Sculco Thomas P, Poultsides Lazaros A
Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
J Arthroplasty. 2017 Feb;32(2):526-531. doi: 10.1016/j.arth.2016.08.002. Epub 2016 Aug 24.
Two-stage exchange arthroplasty remains the preferred method for treating a chronic periprosthetic joint infection (PJI) in North America. However, infection recurrence may occur. Previously, recurrent infections have been classified as persistent (same isolated pathogen) or new (different pathogen identified). We sought to determine (1) recurrence rates among patients with chronic hip and knee PJI, treated with 2-stage exchange arthroplasty; (2) risk factors for infection recurrence; and (3) risk factors for developing persistent vs new infection.
We retrospectively reviewed clinical characteristics of patients with chronic hip and knee PJI, treated with 2-stage revision between January 1998 and March 2014. Minimum follow-up was 24 months. Two multivariate logistic regression models were constructed to determine independent predictors for infection recurrence and persistence.
In total, 548 patients were identified (283 men, 265 women). Forty-eight had a recurrent infection (8.76%). Men had 54.8% lower odds of PJI recurrence than women (odds ratio [OR] = 0.452; 95% confidence interval [CI], 0.235-0.869). Patients with heart disease had 109% higher odds of infection recurrence than patients without heart disease (OR = 2.09; 95% CI, 1.097-3.081). The risk of infection recurrence was 119% higher in patients with psychiatric disorders than in patients without psychiatric disorders (OR = 2.19; 95% CI, 1.011-4.761). Patients with recurrent knee PJI had 84.6% lower odds of persistent infection (OR = 0.154; 95% CI, 0.034-0.696) compared to hip PJI. Patients with heart disease had 5-fold increased odds for persistent PJI (OR = 5.068; 95% CI, 1.38-22.56).
Female gender, heart disease, and psychiatric disorders increase the risk of hip and knee PJI recurrence. Patients with PJI of the hip and with heart disease are at higher risk of infection persistence.
在北美，两阶段翻修置换术仍是治疗慢性人工关节周围感染（PJI）的首选方法。然而，感染可能会复发。此前，复发性感染被分为持续性（同一分离病原体）或新发性（鉴定出不同病原体）。我们试图确定：（1）接受两阶段翻修置换术治疗的慢性髋和膝PJI患者的复发率；（2）感染复发的危险因素；以及（3）发生持续性感染与新发性感染的危险因素。
我们回顾性分析了1998年1月至2014年3月间接受两阶段翻修治疗的慢性髋和膝PJI患者的临床特征。最小随访时间为24个月。构建了两个多变量逻辑回归模型，以确定感染复发和持续性的独立预测因素。
共纳入548例患者（男性283例，女性265例）。48例发生了复发性感染（8.76%）。男性PJI复发的几率比女性低54.8%（比值比[OR]=0.452；95%置信区间[CI]，0.235-0.869）。患有心脏病的患者感染复发的几率比没有心脏病的患者高109%（OR=2.09；95%CI，1.097-3.081）。患有精神疾病的患者感染复发的风险比没有精神疾病的患者高119%（OR=2.19；95%CI，1.011-4.761）。与髋PJI患者相比，复发性膝PJI患者发生持续性感染的几率低84.6%（OR=0.154；95%CI，0.034-0.696）。患有心脏病的患者持续性PJI的几率增加了5倍（OR=5.068；95%CI，1.38-22.56）。
女性、心脏病和精神疾病会增加髋和膝PJI复发的风险。患有髋PJI且患有心脏病的患者感染持续的风险更高。
