Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2020 Jun;35(6S):S10-S14. doi: 10.1016/j.arth.2020.02.054. Epub 2020 Feb 28.
Despite the success of primary total hip arthroplasties (THAs), some patients will require an aseptic reoperation within 1 year of the index THA. The goal of this study is to evaluate the risk of subsequent periprosthetic joint infection (PJI) in patients undergoing an aseptic reoperation within 1 year of a primary THA.
A retrospective review utilizing our institutional joint registry identified 211 primary THAs requiring aseptic reoperation within 1 year following index arthroplasty. A control group of 15,357 primary THAs not requiring reoperation within 1 year was identified. Patients were divided into groups based on time from primary THA to reoperation: (1) within 90 days (n = 112 THAs; 40% for dislocation, 34% for periprosthetic fracture) or (2) 91-365 days (n = 99 THAs; 37% for dislocation, 29% for periprosthetic fracture). Mean follow-up was 7 years.
Patients undergoing an aseptic reoperation within 90 days had a PJI rate of 4.8% at 2 years, while the 91-365 day group had a PJI rate of 3.2% at 2 years. The control group had a PJI rate of 0.2% at 2 years. Employing a multivariate analysis, reoperation within 90 days of index arthroplasty had an elevated risk of PJI (hazard ratio 8, P < .001) as did a reoperation between 91 and 365 days (hazard ratio 13, P < .001).
Aseptic reoperations within 1 year following primary THA resulted in an 8- to 13-fold increased risk of subsequent PJI. The risk was similar whether the aseptic reoperation was early (within 90 days) or later (91-365 days).
Level III (Prognostic).
尽管初次全髋关节置换术（THA）取得了成功，但仍有部分患者在初次 THA 后 1 年内需要进行无菌性翻修手术。本研究旨在评估初次 THA 后 1 年内行无菌性翻修手术患者发生假体周围关节感染（PJI）的风险。
利用我院关节登记处进行回顾性研究，共纳入 211 例初次 THA 后 1 年内需行无菌性翻修手术的患者。另选取 15357 例初次 THA 后 1 年内无需翻修手术的患者作为对照组。根据初次 THA 至翻修手术的时间将患者分为两组：（1）90 天内（n=112 例；40%为脱位，34%为假体周围骨折）或（2）91-365 天内（n=99 例；37%为脱位，29%为假体周围骨折）。平均随访时间为 7 年。
90 天内行无菌性翻修手术的患者在第 2 年时 PJI 发生率为 4.8%，而 91-365 天内行无菌性翻修手术的患者在第 2 年时 PJI 发生率为 3.2%。对照组在第 2 年时 PJI 发生率为 0.2%。多因素分析显示，初次 THA 后 90 天内行翻修手术（风险比 8，P<0.001）和 91-365 天行翻修手术（风险比 13，P<0.001）均会增加 PJI 的发生风险。
初次 THA 后 1 年内行无菌性翻修手术会使随后发生 PJI 的风险增加 8-13 倍。无论无菌性翻修手术是早期（90 天内）还是晚期（91-365 天）进行，风险都相似。
III 级（预后）。
