Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, Beijing, China.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
J Arthroplasty. 2020 Jun;35(6):1696-1702.e1. doi: 10.1016/j.arth.2020.01.080. Epub 2020 Feb 6.
It is unknown whether the outcomes of treatment for periprosthetic joint infection (PJI) are improving with time. This study evaluated trends in PJI treatment outcomes in the hip and knee following 2-stage exchange arthroplasty and irrigation and debridement (I&D) over the last 17 years.
We reviewed 550 two-stage exchange arthroplasties and 194 I&Ds between 2000 and 2016 at our institution. Treatment success was defined according to the Delphi consensus criteria and Kaplan-Meier survivorship curves were generated. A multivariate Cox proportional hazards regression model was generated to determine time trends in the outcome of PJI treatment with the year of surgery included as both a continuous covariate (per 1-year increase) and a categorical covariate (2000-2010 or 2011-2016).
The survivorship of I&D, 2-stage revision, and the total combined cohort were comparable between 2000-2010 and 2011-2016 groups. Multivariate Cox regression analysis showed that the year of surgery was not associated with treatment failure following an I&D or 2-stage exchange arthroplasty, and neither did it increase the risk of non-reimplantation. When year of surgery was considered as a categorical variable, there remained no significant difference in treatment failure following an I&D or 2-stage exchange arthroplasty between the 2000-2010 cohort and 2011-2016 cohort.
Despite the increasing clinical focus, research advances, and growing literature relating to PJI, we were unable to detect any substantial improvement in the treatment success rates of PJI at our institution over the 17 years examined in this study. Novel treatments and techniques are certainly needed as current and prior strategies remain far from optimal.
目前尚不清楚治疗人工关节周围感染（PJI）的效果是否随时间推移而改善。本研究评估了过去 17 年我院采用 2 期关节置换术和清创冲洗术（I&D）治疗髋关节和膝关节 PJI 的效果趋势。
我们回顾了 2000 年至 2016 年我院 550 例 2 期关节置换术和 194 例 I&D 患者的资料。根据 Delphi 共识标准定义治疗成功，生成 Kaplan-Meier 生存曲线。采用多变量 Cox 比例风险回归模型，以手术年份作为连续变量（每年增加 1 年）和分类变量（2000-2010 年或 2011-2016 年），确定 PJI 治疗效果的时间趋势。
2000-2010 年和 2011-2016 年 I&D、2 期翻修和总合并队列的生存率无差异。多变量 Cox 回归分析显示，手术年份与 I&D 或 2 期关节置换术治疗失败无关，也不会增加非再植入的风险。当手术年份作为分类变量时，I&D 或 2 期关节置换术后治疗失败在 2000-2010 年和 2011-2016 年组之间仍无显著差异。
尽管临床关注度、研究进展和与 PJI 相关的文献不断增加，但在本研究中，我们仍无法发现我院在过去 17 年中 PJI 治疗成功率有显著提高。由于目前和之前的策略远非最佳，确实需要新的治疗方法和技术。
