Department of Orthopedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
J Arthroplasty. 2018 May;33(5):1515-1519. doi: 10.1016/j.arth.2017.12.010. Epub 2017 Dec 14.
The diagnosis of periprosthetic joint infection (PJI) can be made when 1 major criterion or 3 of 5 minor criteria are present. However, the outcomes of patients with a major vs minor criteria for diagnosis have not been studied. The objective of this study was to evaluate if a difference in outcome of surgical intervention existed between patients with PJI who were diagnosed with a major criterion or a combination of minor criteria.
A retrospective chart review identified 277 primary total hip or knee arthroplasty patients who had developed PJI based on the International Consensus Meeting definition. Patients were further stratified into "major" vs "minor" groups. Patient demographics, PJI workup, surgical treatment, microbiological growth, and clinical outcomes were recorded. Treatment success was defined by using the Delphi criteria. Standard statistical analysis was performed.
Overall, 34 patients met minor-only criteria (12.2%), whereas 243 met major criteria. Of the minor-only patients, 16 (47%) were culture negative. When controlling for confounding variables, there was no statistically significant difference with regard to treatment success (minor 94.1% vs major 82.3%, P = .085) between groups at final follow-up (mean 110 months, range 2.3-567 months). Only higher Charlson comorbidity index (P = .001) and an initial 2-stage surgical procedure (P = .003) were associated with decreased treatment success.
PJI patients were similar between both criteria groups, and there was no difference in treatment success as defined by the Delphi criteria between minor-only PJI and major criteria PJI patients.
当存在 1 项主要标准或 5 项次要标准中的 3 项时，可诊断为假体周围关节感染 (PJI)。然而，尚未研究具有主要诊断标准与具有多项次要诊断标准的患者的结局是否存在差异。本研究的目的是评估在使用主要标准或多项次要标准诊断 PJI 的患者中，手术干预的结果是否存在差异。
回顾性病历分析确定了 277 例基于国际共识会议定义发生 PJI 的初次全髋关节或膝关节置换患者。患者进一步分为“主要”和“次要”组。记录患者的人口统计学资料、PJI 检查、手术治疗、微生物生长和临床结局。采用 Delphi 标准定义治疗成功。进行了标准的统计分析。
总体而言，34 例患者符合仅次要标准 (12.2%)，而 243 例患者符合主要标准。仅次要患者中有 16 例 (47%) 培养结果为阴性。在控制混杂变量后，最终随访时两组之间在治疗成功率方面无统计学差异（次要组 94.1%，主要组 82.3%，P=.085）（平均随访时间为 110 个月，范围为 2.3-567 个月）。仅Charlson 合并症指数较高（P=.001）和初始两阶段手术（P=.003）与治疗成功率降低相关。
两组患者在 PJI 方面相似，根据 Delphi 标准，仅次要 PJI 与主要标准 PJI 患者的治疗成功率无差异。
