Anderson Mike B, Curtin Karen, Wong Jathine, Pelt Christopher E, Peters Christopher L, Gililland Jeremy M
1Departments of Orthopaedics (M.B.A., C.E.P., C.L.P, and J.M.G.) and Internal Medicine (K.C.), University of Utah, Salt Lake City, Utah 2Pedigree and Population Resource, The University of Utah and Huntsman Cancer Institute, Salt Lake City, Utah.
J Bone Joint Surg Am. 2017 Jun 7;99(11):905-913. doi: 10.2106/JBJS.16.00514.
It is estimated that the cost to treat periprosthetic joint infection in the United States will approach $1.62 billion by 2020. Thus, the need to better understand the pathogenesis of periprosthetic joint infection is evident. We performed a population-based, retrospective cohort study to determine if familial clustering of periprosthetic joint infection was observed.
Analyses were conducted using software developed at the Utah Population Database (UPDB) in conjunction with the software package R. The cohort was obtained by querying the UPDB for all patients undergoing total joint arthroplasty and for those patients who had subsequent periprosthetic joint infection. The magnitude of familial risk was estimated by hazard ratios (HRs) from Cox regression models to assess the relative risk of periprosthetic joint infection in relatives and spouses. Using percentiles for age strata, we adjusted for sex, body mass index (BMI) of ≥30 kg/m, and a history of smoking, diabetes, and/or end-stage renal disease. Additionally, we identified families with excess clustering of periprosthetic joint infection above that expected in the population using the familial standardized incidence ratio.
A total of 66,985 patients underwent total joint arthroplasty and 1,530 patients (2.3%) had a periprosthetic joint infection. The risk of periprosthetic joint infection following total joint arthroplasty was elevated in first-degree relatives (HR, 2.16 [95% confidence interval (CI), 1.29 to 3.59]) and combined first and second-degree relatives (HR, 1.79 [95% CI, 1.22 to 2.62]). Further, 116 high-risk pedigrees with a familial standardized incidence ratio of >2 and a p value of <0.05 were identified and 9 were selected for genotyping studies based on the observed periprosthetic joint infection/total joint arthroplasty ratio and visual inspection of the pedigrees for lack of excessive comorbidities.
Although preliminary, these data may help to guide further genetic research associated with periprosthetic joint infections. An understanding of familial risks could lead to new discoveries in creating patient-centered pathways for infection prevention in patients at risk.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
据估计，到2020年，美国治疗人工关节周围感染的费用将接近16.2亿美元。因此，显然有必要更好地了解人工关节周围感染的发病机制。我们进行了一项基于人群的回顾性队列研究，以确定是否观察到人工关节周围感染的家族聚集性。
使用犹他州人口数据库（UPDB）开发的软件结合R软件包进行分析。通过查询UPDB获取所有接受全关节置换术的患者以及随后发生人工关节周围感染的患者组成队列。通过Cox回归模型的风险比（HR）估计家族风险的大小，以评估亲属和配偶中人工关节周围感染的相对风险。使用年龄分层百分位数，我们对性别、体重指数（BMI）≥30 kg/m²以及吸烟、糖尿病和/或终末期肾病病史进行了调整。此外，我们使用家族标准化发病率比确定了人工关节周围感染聚集超过人群预期的家族，并通过观察人工关节周围感染/全关节置换术比例以及对家族进行目视检查以排除过多合并症，选择了9个家族进行基因分型研究。
共有66985例患者接受了全关节置换术，其中1530例患者（2.3%）发生了人工关节周围感染。全关节置换术后，一级亲属发生人工关节周围感染的风险升高（HR，2.16 [95%置信区间（CI），1.29至3.59]），一级和二级亲属合并发生人工关节周围感染的风险升高（HR，1.79 [95% CI，1.22至2.62]）。此外，确定了116个家族标准化发病率比>2且p值<0.05的高危家系，并根据观察到的人工关节周围感染/全关节置换术比例以及对家系进行目视检查以排除过多合并症，选择了9个家系进行基因分型研究。
尽管这些数据是初步的，但可能有助于指导与人工关节周围感染相关的进一步基因研究。了解家族风险可能会在为有感染风险的患者创建以患者为中心的预防感染途径方面带来新的发现。
预后III级。有关证据水平的完整描述，请参阅作者指南。
