Lenguerrand Erik, Whitehouse Michael R, Beswick Andrew D, Toms Andrew D, Porter Martyn L, Blom Ashley W
Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, Bristol, UK.
Exeter Knee Reconstruction Unit, Royal Devon and Exeter NHS Foundation Trust, Princess Elizabeth Orthopaedic Centre, Exeter, UK.
BMJ Open. 2017 Jul 10;7(7):e014056. doi: 10.1136/bmjopen-2016-014056.
To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level.
We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression.
The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014.
Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres.
描述膝关节置换患者中用于治疗人工关节感染（PJI）的翻修手术的患病率、时间趋势、PJI翻修的累积发病率函数，并估计卫生服务层面PJI的负担。
我们分析了2003年至2014年在英格兰和威尔士国家关节注册中心记录的因诊断为PJI而进行的膝关节翻修置换手术以及相关的初次手术。分析的队列包括679010例初次全膝关节置换、33920例初次膝关节翻修置换以及8247例因诊断为PJI而进行的全膝关节翻修置换。计算了患病率、从初次手术到PJI翻修的时间所调查的时间趋势、累积发病率函数以及PJI的负担（总手术量）。采用对数线性回归研究总体线性趋势。
初次全膝关节置换后2年因PJI进行翻修置换的发生率为3.2/1000，膝关节翻修置换后为14.4/1000。初次膝关节置换后3个月内PJI翻修的患病率从2005年到2013年上升了2.5倍（95%CI 1.2至5.3），膝关节翻修置换后上升了7.5倍（95%CI 1.0至56.1）。每年因膝关节PJI进行的手术超过1000例，从2005年到2013年增加了2.8例。总体而言，75%的翻修是两阶段的，单阶段的使用从2005年的7.9%增加到2014年的18.8%。
虽然膝关节置换后因PJI进行翻修的风险较低，但呈上升趋势，再加上初次和翻修膝关节置换既定的以及进一步预测的发病率增加，这对英格兰和威尔士的骨科服务提供构成了日益增加且巨大的治疗负担。这对未来的服务设计以及个体和专科中心的资金投入具有影响。
