Division of Arthroplasty, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
Warren Alpert Medical School of Brown University, Providence, RI.
J Arthroplasty. 2019 Jan;34(1):116-122. doi: 10.1016/j.arth.2018.09.037. Epub 2018 Sep 20.
Sarcopenia, an age-related loss of muscle mass and function, has been previously linked to an increased risk of morbidity, mortality, and infection after a variety of surgical procedures. This study is the first to evaluate the impact of the psoas-lumbar vertebral index (PLVI), a validated marker for central sarcopenia, on determining post-arthroplasty infection status.
This is a case-control, retrospective review of 30 patients with prosthetic joint infection (PJI) diagnosed by the Musculoskeletal Infection Society criteria compared to 69 control patients who underwent a total hip or knee arthroplasty. All patients had a recent computed tomography scan of the abdomen/pelvis to calculate the PLVI. PLVI was evaluated alongside age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, and smoking status to determine the predictive value for infection.
Notably, the infected group had a large, significant difference in their average PLVI (0.736 vs 0.963, P < .001). The patient's PLVI was a predictor of infection status, with a higher PLVI being protective against infection (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.109-0.715, P = .008). Additional predictors of infection status were higher American Society of Anesthesiologists score (OR 10.634, 95% CI 3.112-36.345, P < .001) and Charlson Comorbidity Index (OR 1.438, 95% CI 1.155-1.791, P = .001). Multivariate, binary logistic regression analysis confirmed that PLVI was a significant independent predictor of infection status (B = -0.685, P = .039).
PLVI, a marker for central sarcopenia, was demonstrated to be a risk factor for PJI. Further research and consideration of sarcopenia as a screening and optimizable risk factor for total joint arthroplasty must be explored.
肌少症是一种与年龄相关的肌肉质量和功能丧失，先前与多种手术后发病率、死亡率和感染风险增加有关。本研究首次评估了验证性的中央性肌少症标志物——腰大肌-腰椎指数（PLVI）对确定关节置换术后感染状态的影响。
这是一项病例对照、回顾性研究，纳入了 30 例符合 Musculoskeletal Infection Society 标准的假体关节感染（PJI）患者作为感染组，以及 69 例接受全髋关节或膝关节置换术的患者作为对照组。所有患者最近均接受了腹部/骨盆 CT 扫描以计算 PLVI。评估了 PLVI 与年龄、性别、体重指数、Charlson 合并症指数、美国麻醉医师协会评分和吸烟状况，以确定其对感染的预测价值。
值得注意的是，感染组的平均 PLVI 显著较大（0.736 比 0.963，P <.001）。患者的 PLVI 是感染状态的预测指标，较高的 PLVI 可降低感染风险（比值比 [OR] 0.28，95%置信区间 [CI] 0.109-0.715，P =.008）。感染状态的其他预测指标包括较高的美国麻醉医师协会评分（OR 10.634，95% CI 3.112-36.345，P <.001）和 Charlson 合并症指数（OR 1.438，95% CI 1.155-1.791，P =.001）。多变量二项逻辑回归分析证实 PLVI 是感染状态的显著独立预测指标（B = -0.685，P =.039）。
PLVI 作为中央性肌少症的标志物，被证明是 PJI 的危险因素。必须进一步研究并考虑将肌少症作为全关节置换术的筛查和可优化的危险因素。
