Department of Orthopedics, University of California, Davis Medical Center, Sacramento, CA.
J Arthroplasty. 2018 Dec;33(12):3783-3788. doi: 10.1016/j.arth.2018.08.021. Epub 2018 Aug 25.
Periprosthetic joint infections (PJIs) are fraught with multiple complications including poor patient-reported outcomes, disability, reinfection, disarticulation, and even death. We sought to perform a systematic review asking the question: (1) What is the mortality rate of a PJI of the knee undergoing 2-stage revision for infection? (2) Has this rate improved over time? (3) How does this compare to a normal cohort of individuals?
We performed a database search in MEDLINE/EMBASE, PubMed, and all relevant reference studies using the following keywords: "periprosthetic joint infection," "mortality rates," "total knee arthroplasty," and "outcomes after two stage revision." Two hundred forty-two relevant studies and citations were identified, and 14 studies were extracted and included in the review.
A total of 20,719 patients underwent 2-stage revision for total knee PJI. Average age was 66 years. Mean mortality percentage reported was 14.4% (1.7%-34.0%) with average follow-up 3.8 years (0.25-9 years). One-year mortality rate was 4.33% (3.14%-5.51%) after total knee PJI with an increase of 3.13% per year mortality thereafter (r = 0.76 [0.49, 0.90], P < .001). Five-year mortality was 21.64%. When comparing the national age-adjusted mortality (Actuarial Life Table) and the reported 1-year mortality risk in this meta-analysis, the risk of death after total knee PJI is significantly increased, with an odds ratio of 3.05 (95% confidence interval, 2.69-3.44; P < .001).
The mortality rate after 2-stage total knee revision for infection is very high. When counseling a patient regarding complications of this disease, death should be discussed.
人工关节周围感染（PJI）并发症众多，包括患者报告结局不佳、残疾、再感染、关节脱位，甚至死亡。我们旨在进行一项系统评价，提出以下问题：（1）接受 2 期翻修治疗感染的膝关节 PJI 的死亡率是多少？（2）该死亡率是否随时间改善？（3）与正常人群相比如何？
我们在 MEDLINE/EMBASE、PubMed 和所有相关参考文献中使用以下关键词进行数据库检索：“人工关节周围感染”、“死亡率”、“全膝关节置换术”和“2 期翻修后结局”。共确定了 242 项相关研究和参考文献，提取并纳入了 14 项研究进行综述。
共有 20719 例患者接受了全膝关节 PJI 的 2 期翻修。平均年龄为 66 岁。报告的平均死亡率为 14.4%（1.7%-34.0%），平均随访时间为 3.8 年（0.25-9 年）。全膝关节 PJI 后 1 年死亡率为 4.33%（3.14%-5.51%），此后每年死亡率增加 3.13%（r=0.76 [0.49, 0.90]，P<0.001）。5 年死亡率为 21.64%。将全膝关节 PJI 后 1 年的死亡率与国家年龄调整死亡率（ actuarial life table）进行比较，发现全膝关节 PJI 后死亡的风险显著增加，优势比为 3.05（95%置信区间，2.69-3.44；P<0.001）。
接受 2 期全膝关节翻修治疗感染的死亡率非常高。在向患者提供这种疾病并发症的咨询时，应该讨论死亡问题。
