Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
Department of Surgery, Ruhr-University Hospital, Bochum, Germany.
J Bone Joint Surg Am. 2019 Jun 19;101(12):1061-1069. doi: 10.2106/JBJS.18.00947.
One-stage exchange arthroplasty in the management of periprosthetic joint infection was introduced at our institution. The purpose of this study was to analyze the risk factors of failure after periprosthetic joint infection following total knee arthroplasty treated with 1-stage exchange.
Ninety-one patients who underwent failed treatment following 1-stage exchange total knee arthroplasty due to periprosthetic joint infection from January 2008 to December 2017 were included. From the same period, we randomly selected a 1:1 matched control group without a subsequent revision surgical procedure. Bivariate analyses, including preoperative, intraoperative, and postoperative factors, as well as logistic regression, were performed to identify risk factors for failure.
Bivariate analysis yielded 10 predictors (variables with significance at p < 0.05) for failure involving re-revision for any reason and 11 predictors for failure involving re-revision for reinfection. The binary logistic regression model revealed the following risk factors for re-revision for any reason: history of a 1-stage exchange for infection (odds ratio [OR], 26.706 [95% confidence interval (CI), 5.770 to 123.606]; p < 0.001), history of a 2-stage exchange (OR, 3.948 [95% CI, 1.869 to 8.339]; p < 0.001), and isolation of enterococci (OR, 16.925 [95% CI, 2.033 to 140.872]; p = 0.009). The risk factors for reinfection in the binary logistic regression analysis were history of 1-stage or 2-stage exchange arthroplasty, isolation of enterococci, and isolation of streptococci (OR, 6.025 [95% CI, 1.470 to 24.701]; p = 0.013).
We identified several risk factors of failure after 1-stage exchange arthroplasty for periprosthetic joint infection, most of which were not related to the patient comorbidities. Among them, previous exchange due to periprosthetic joint infection and the isolation of Enterococcus or Streptococcus species were associated with a higher risk of failure. Besides a multidisciplinary approach, being aware of the identified risk factors when evaluating patients with periprosthetic joint infection could lead to better outcomes.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
我院引入了一期关节置换术治疗人工关节周围感染。本研究旨在分析一期翻修治疗全膝关节置换术后人工关节周围感染失败的危险因素。
纳入 2008 年 1 月至 2017 年 12 月期间因人工关节周围感染行一期翻修失败的 91 例患者。同期随机选择 1:1 配对的无后续翻修手术的对照组。进行双变量分析，包括术前、术中、术后因素和 logistic 回归分析，以确定失败的危险因素。
双变量分析得出 10 个与任何原因的再次翻修相关的预测因子（p < 0.05 的变量）和 11 个与再感染相关的再次翻修的预测因子。二项逻辑回归模型显示，再次翻修的危险因素包括：一期感染翻修史（优势比[OR]，26.706[95%置信区间（CI），5.770 至 123.606]；p < 0.001）、二期翻修史（OR，3.948[95%CI，1.869 至 8.339]；p < 0.001）和肠球菌的分离（OR，16.925[95%CI，2.033 至 140.872]；p = 0.009）。二项逻辑回归分析中再感染的危险因素包括一期或二期关节置换术、肠球菌和链球菌的分离（OR，6.025[95%CI，1.470 至 24.701]；p = 0.013）。
我们确定了一期关节置换术治疗人工关节周围感染后失败的几个危险因素，其中大多数与患者的合并症无关。其中，先前因人工关节周围感染而进行的关节置换术以及肠球菌或链球菌的分离与较高的失败风险相关。除了多学科方法外，在评估人工关节周围感染患者时，了解已确定的危险因素可以带来更好的结果。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
