National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, United Kingdom.
Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, United Kingdom.
J Infect. 2020 Apr;80(4):426-436. doi: 10.1016/j.jinf.2020.01.008. Epub 2020 Jan 22.
We conducted a systematic meta-analysis to evaluate the incidence, temporal trends and potential risk factors for prosthetic joint infection (PJI) following primary total shoulder replacement (TSR) and elbow replacement (TER).
Longitudinal studies reporting infection outcomes following primary TSR or TER were sought from MEDLINE, Embase and Cochrane Library up to June 2019. Incidence rates and relative risks (with 95% CIs) were calculated.
The search identified 105 eligible articles (108 non-overlapping studies). There were 631,854 TSRs (1,751 PJIs) and 17,485 TERs (525 PJIs). The pooled PJI incidence following TSR was 0.61% (0.34-0.93) over a follow-up period of 1.1 years. The corresponding incidence following TER was 2.53% (1.99-3.12) over a follow-up period of 3.3 years. Shoulder and elbow PJI incidence declined from the 1990s to 2010 and beyond. Males, younger age (<75 years), previous shoulder surgery, reverse TSR, rotator cuff arthropathy and inpatient TSR increased shoulder PJI risk. For TER, high body mass index, psychiatric illness, and previous elbow surgery increased PJI risk.
Shoulder and elbow PJI may be on a temporal decline. Caution should be taken for patients at high PJI risk following primary TSR such as younger males and patients with a previous shoulder surgery.
我们进行了一项系统的荟萃分析，以评估初次全肩关节置换术（TSR）和全肘关节置换术（TER）后人工关节感染（PJI）的发生率、时间趋势和潜在危险因素。
从 MEDLINE、Embase 和 Cochrane Library 中检索截至 2019 年 6 月报告初次 TSR 或 TER 后感染结果的纵向研究。计算发病率和相对风险（95%置信区间）。
搜索确定了 105 篇合格文章（108 篇不重叠研究）。有 631854 例 TSR（1751 例 PJI）和 17485 例 TER（525 例 PJI）。TSR 后 PJI 的累积发病率为 0.61%（0.34-0.93），随访时间为 1.1 年。TER 后相应的发病率为 2.53%（1.99-3.12），随访时间为 3.3 年。肩部和肘部 PJI 的发病率从 20 世纪 90 年代到 2010 年及以后呈下降趋势。男性、年龄较小（<75 岁）、既往肩部手术、反向 TSR、肩袖关节炎和住院 TSR 增加了肩部 PJI 的风险。对于 TER，高身体质量指数、精神疾病和既往肘部手术增加了 PJI 的风险。
肩部和肘部 PJI 可能呈时间下降趋势。对于初次 TSR 后 PJI 风险较高的患者，如年轻男性和既往肩部手术患者，应谨慎对待。
