Department of Orthopedic and Trauma Surgery University Campus Bio-Medico of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):129-138. doi: 10.26355/eurrev_201904_17482.
The purpose of our study is to assess the incidence of prosthetic joint infection (PJI) after total Knee arthroplasty (TKA), total Hip arthroplasty (THA) and total Shoulder arthroplasty (TSA), to identify risk factors, determine the microbial spectrum and management's outcome.
A case-control, retrospective observational study was performed analyzing patients who developed a PJI after TKA, THA, and TSA from 2000 to 2017 at our hospital. The patient's risk profile was defined extracting from clinical records the following data: sex, age, BMI, type of implant, comorbidity, year of surgery, year of infection, previous intra-articular injection, microbial isolation, medical and surgical management outcome. We include in the "control group" for each "case" at least 3 patients who didn't have a PJI after TJA.
28 patients met all inclusion and exclusion criteria. Comparing the "cases" with "controls" demographics parameters, medical comorbidities and previous intra-articular injection were not associated with an increased risk of PJI. Comparing the "early/delayed group" with "late group", BMI was associated with an increased risk of early/delayed PJI, while demographics parameters, medical comorbidities, and previous intra-articular injection did not significantly increase the risk of PJI. Logistic regression showed that for each BMI unit there was a 20-fold increased risk of early prosthetic infection (OR 1.19, IC 1.03-1.38, p=0.01). Staphylococci were isolated most frequently from pre-operative and intra-operative cultures. Two-stage arthroplasty exchange and surgical debridement resulted in the most performed surgical treatment with a success rate of 88 and 87%.
Obesity is a risk factor for "early/delayed infection" of TJA. Two-stage arthroplasty exchange, debridement, antibiotics, and implant retention in patients are treatments with a high rate of success in terms of reinfection.
我们研究的目的是评估全膝关节置换术（TKA）、全髋关节置换术（THA）和全肩关节置换术（TSA）后假体关节感染（PJI）的发生率，确定危险因素，确定微生物谱和治疗结果。
对 2000 年至 2017 年期间在我院发生 TKA、THA 和 TSA 后发生 PJI 的患者进行了病例对照、回顾性观察研究。从临床记录中提取患者的风险特征，包括：性别、年龄、BMI、植入物类型、合并症、手术年份、感染年份、关节内注射、微生物分离、医疗和手术管理结果。我们将每个 TJA 后未发生 PJI 的患者纳入“对照组”。
28 名患者均符合所有纳入和排除标准。比较“病例”和“对照组”的人口统计学参数、医疗合并症和关节内注射与 PJI 风险增加无关。比较“早期/延迟组”与“晚期组”，BMI 与早期/延迟 PJI 风险增加相关，而人口统计学参数、医疗合并症和关节内注射未显著增加 PJI 风险。Logistic 回归显示，BMI 每增加一个单位，早期假体感染的风险增加 20 倍（OR 1.19，IC 1.03-1.38，p=0.01）。术前和术中培养最常分离出葡萄球菌。二期关节置换术和清创术是最常进行的手术治疗，成功率分别为 88%和 87%。
肥胖是 TJA“早期/延迟感染”的危险因素。二期关节置换术、清创术、抗生素和保留植入物是治疗再感染的有效方法，成功率高。
