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 Jul;35(7):1906-1911.e5. doi: 10.1016/j.arth.2020.02.017. Epub 2020 Feb 15.
Although there is an increasing trend toward reporting the outcome of hip and knee arthroplasty separately, it remains unknown whether joint-specific reporting is necessary for periprosthetic joint infection (PJI) as sample sizes are already low, given its relatively rare occurrence. The aim of this study is to compare treatment outcomes of PJI occurring after knee and hip arthroplasty. Furthermore, we aim to establish the necessary follow-up time for an accurate reporting of PJI treatment outcomes.
A retrospective study of 792 cases of hip and knee PJI treated with irrigation and debridement or two-stage exchange arthroplasty from 2000 to 2017 was performed. Treatment failure was defined based on the Delphi method-based criteria. The Kaplan-Meier survivorship curves were generated, and a log-rank test was used to evaluate differences in survivorship. A multivariate Cox proportional hazards regression and a sensitivity analysis using propensity matching were performed. A two-piecewise linear regression model was used to examine the threshold effect of time after treatment on survival rates.
There were no significant differences between hip and knee PJIs in overall survivorship (P = .71), or when stratified by irrigation and debridement (P = .39), or two-stage exchange arthroplasty (P = .59). There was also no difference by joint in the multivariate or sensitivity analysis. Survival rates had the most dramatic rates of decrease in the initial months after treatment of PJI but began to plateau after 1.09 years.
This study reveals no difference in treatment outcomes between knee and hip PJIs. In addition, given the difficulty with obtaining follow-up, we suggest that one-year follow-up is sufficient for an accurate reporting of treatment failure.
尽管髋关节和膝关节置换术的结果分别报告的趋势日益增加，但由于假体周围关节感染（PJI）的发生率相对较低，样本量已经很小，因此是否需要针对关节特异性报告仍不清楚。本研究旨在比较膝关节和髋关节置换术后发生 PJI 的治疗结果。此外，我们旨在确定准确报告 PJI 治疗结果所需的随访时间。
对 2000 年至 2017 年期间接受灌洗和清创术或二期置换术治疗的 792 例髋膝关节 PJI 病例进行回顾性研究。根据 Delphi 方法为基础的标准定义治疗失败。生成 Kaplan-Meier 生存曲线，并使用对数秩检验评估生存差异。进行多变量 Cox 比例风险回归和使用倾向匹配的敏感性分析。使用两段线性回归模型检查治疗后时间对生存率的阈值效应。
髋膝关节 PJI 在总体生存率（P =.71）方面，或在灌洗和清创术（P =.39）或二期置换术（P =.59）分层方面均无显著差异。多变量或敏感性分析中关节之间也没有差异。治疗后 PJI 的最初几个月生存率下降幅度最大，但在 1.09 年后开始趋于平稳。
本研究表明膝关节和髋关节 PJI 的治疗结果无差异。此外，鉴于获得随访的困难，我们建议一年的随访足以准确报告治疗失败。
