Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France; Service de médecine interne et rhumatologie, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France.
Centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France; Service de médecine interne et rhumatologie, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France.
Joint Bone Spine. 2019 May;86(3):369-372. doi: 10.1016/j.jbspin.2019.01.017. Epub 2019 Feb 6.
Prosthetic joint infection (PJI) is a serious complication of joint replacement surgery. The major pharmacological and surgical treatments required by PJI increase the risk of peri-operative complications in elderly patients. The increase in life expectancy combined with procedural advances make these treatments possible even in the oldest patients. Here, our objective was to compare the characteristics and outcomes of curative PJI treatment in patients < 80 years vs. ≥ 80 years.
A prospective single-center design was used to compare the characteristics and outcomes of curative treatment for hip or knee PJI in patients < 80 years and ≥ 80 years admitted in 2004-2014.
Of 765 patients admitted for PJI, 590 were < 80 years and 124 were ≥ 80 years. Medical history and comorbidities were similar in the two groups. The older group had a significantly higher proportion of patients with American Society of Anesthesiologists Scores ≥ 3 and with streptococcal infection (20% vs. 13%, P < 0.05). After complete surgical excision and prolonged antibiotic therapy, the only event whose frequency differed significantly between the two groups was PJI-related death, which was more common in the older patients (6.5% vs. 0.8%, P < 0.05). The 2-year survival rate after one-stage exchange arthroplasty was > 90% in the ≥80 year group.
Patients aged 80 years or older are eligible for the same curative pharmacological and surgical PJI treatments used in their younger counterparts. Before surgery, the risk/benefit ratio of the major surgical procedure required to treat PJI must be assessed on a case-by-case basis.
人工关节感染（PJI）是关节置换手术后的一种严重并发症。PJI 所需的主要药物和手术治疗会增加老年患者围手术期并发症的风险。预期寿命的增加加上手术技术的进步，使得这些治疗方法即使在最年长的患者中也成为可能。在这里，我们的目的是比较 80 岁以下和 80 岁及以上患者的根治性 PJI 治疗的特征和结果。
采用前瞻性单中心设计，比较 2004 年至 2014 年收治的髋或膝关节 PJI 患者中年龄＜80 岁和≥80 岁患者的治疗特征和结果。
在 765 名患有 PJI 的患者中，590 名患者年龄＜80 岁，124 名患者年龄≥80 岁。两组患者的病史和合并症相似。老年组中，美国麻醉医师协会评分≥3 分和链球菌感染的患者比例显著较高（20%比 13%，P＜0.05）。在彻底的手术切除和延长抗生素治疗后，两组之间唯一有显著差异的事件是与 PJI 相关的死亡，老年患者更为常见（6.5%比 0.8%，P＜0.05）。在一期关节置换术治疗后，≥80 岁组的 2 年生存率＞90%。
80 岁或以上的患者有资格接受与年轻患者相同的根治性药物和手术 PJI 治疗。在手术前，必须根据具体情况评估治疗 PJI 所需的主要手术的风险/获益比。
