Anis Hiba K, Ramanathan Deepak, Sodhi Nipun, Klika Alison K, Piuzzi Nicolas S, Mont Michael A, Higuera Carlos A, Molloy Robert M
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York.
J Knee Surg. 2019 Nov;32(11):1058-1062. doi: 10.1055/s-0039-1678678. Epub 2019 Feb 12.
The ongoing debate on fixation in total knee arthroplasty (TKA) has become increasingly relevant with its increased use in a younger patient population and the advent of novel cementless prostheses. Recent literature suggests modern cementless implants are comparable to their cemented counterparts in terms of survivorship and functional outcomes. What has not been well-assessed is whether the two modalities differ with respect to infection rates which was the purpose of this study. Specifically, a propensity score matched study population was used to compare: (1) overall infection; (2) prosthetic joint infection (PJI); and (3) surgical site infection (SSI) rates between cementless and cemented TKAs. Using a large institutional database, 3,180 consecutive primary TKAs were identified. Cementless and cemented TKA patients were propensity score matched by age ( = 0.069), sex ( = 0.395), body mass index (BMI; = 0.308), and Charlson's comorbidity index (CCI) score ( = 0.616) in a 1:1 ratio. Univariate analysis was performed to compare 2-year overall infection rates. Infections were further analyzed separately as PJIs (deep joint infections requiring surgery) and SSIs (skin/superficial wound infections). Multivariate logistic regression was performed to evaluate infection incidences after adjusting for procedure-related factors (i.e., operative time, hospital volume, and surgeon volume). There were no significant differences between the matched cohorts in terms of overall infection rates (3.8 vs. 2.3%, = 0.722), as well as when PJI ( = 1.000) and SSI ( = 1.000) rates were analyzed separately. Multivariate analysis revealed no significant differences in overall postoperative infection rates ( = 0.285), PJI rates ( = 0.446), or SSI rates ( = 0.453) even after adjusting for procedure-related factors. There is increasing literature investigating various outcomes demonstrating the comparable efficacies of cementless versus cemented TKAs. To the best of the author's knowledge, this was the first matched case-control study to directly compare their post-operative infection rates. The findings from this study show that post-operative infection rates were similar between fixation modalities even after accounting for a range of patient- and procedure-related factors.
随着全膝关节置换术（TKA）在年轻患者群体中的使用增加以及新型非骨水泥假体的出现，关于TKA固定方式的持续争论变得越来越重要。近期文献表明，就生存率和功能结果而言，现代非骨水泥植入物与其骨水泥型对应物相当。尚未得到充分评估的是，这两种方式在感染率方面是否存在差异，而这正是本研究的目的。具体而言，本研究使用倾向评分匹配的研究人群来比较：（1）总体感染；（2）人工关节感染（PJI）；以及（3）非骨水泥型和骨水泥型TKA之间的手术部位感染（SSI）率。利用一个大型机构数据库，确定了3180例连续的初次TKA病例。非骨水泥型和骨水泥型TKA患者按照年龄（=0.069）、性别（=0.395）、体重指数（BMI；=0.308）和查尔森合并症指数（CCI）评分（=0.616）以1:1的比例进行倾向评分匹配。进行单因素分析以比较2年总体感染率。感染进一步分别作为PJI（需要手术的深部关节感染）和SSI（皮肤/浅表伤口感染）进行分析。进行多因素逻辑回归以评估在调整与手术相关的因素（即手术时间、医院规模和外科医生手术量）后感染发生率。在总体感染率方面（3.8%对2.3%，=0.722），以及分别分析PJI（=1.000）和SSI（=1.000）率时，匹配队列之间没有显著差异。多因素分析显示，即使在调整与手术相关的因素后，总体术后感染率（=0.285）、PJI率（=0.446）或SSI率（=0.453）也没有显著差异。越来越多的文献研究了各种结果，表明非骨水泥型与骨水泥型TKA具有相当的疗效。据作者所知，这是第一项直接比较其术后感染率的匹配病例对照研究。本研究的结果表明，即使在考虑一系列与患者和手术相关的因素后，固定方式之间的术后感染率相似。
