Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
J Arthroplasty. 2020 Jul;35(7):1900-1905. doi: 10.1016/j.arth.2020.02.058. Epub 2020 Mar 5.
Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, carrying significant economic and personal burden. The goal of this study is to use an established database to analyze socioeconomic variables and assess their relationship to PJI. Additionally, we sought to evaluate whether socioeconomic factors, along with other known risk factors of PJI, when controlled for in a statistical model affected the familial risk of PJI.
With approval from our Institutional Review Board we performed a population-based retrospective cohort study on all primary total joint arthroplasty cases of the hip or knee (n = 85,332), within a statewide database, between January 1996 and December 2013. We excluded 9854 patients due to age <18 years, missing data, history of PJI prior to index procedure, and no evidence of 2-year follow-up (excluding those with PJI). Cases that developed PJI following the index procedure (n = 2282) were compared to those that did not (n = 73,196).
After adjusting for covariates, patients with Medicaid as a primary payer were at greater risk for experiencing PJI (relative risk 1.40, 95% confidence interval [CI] 1.08-1.82, P = .01). There was no difference in risk between the groups associated with education level or median household income (all, P > .05). First-degree relatives of patients who develop PJI (hazard ratio 1.66, 95% CI 1.23-2.24, P = .001) and first-degree and second-degree relatives combined (hazard ratio 1.39, 95% CI 1.09-1.77, P = .007) were at greater risk despite controlling for the above socioeconomic factors.
Our study provides further support that genetic factors may underlie PJI as we did observe significant familial risk even after accounting for socioeconomic factors and payer status. We did not find a correlation between education level or household income and PJI; however, Medicaid payees were at increased risk. Continued study is needed to define a possible heritable disposition to PJI in an effort to optimize treatment and possibly prevent this complication.
假体周围关节感染（PJI）是全关节置换术后一种毁灭性的并发症，给个人和社会带来了巨大的经济和个人负担。本研究的目的是使用已建立的数据库来分析社会经济变量，并评估其与 PJI 的关系。此外，我们还试图评估在统计模型中控制其他已知的 PJI 危险因素后，社会经济因素是否以及如何影响 PJI 的家族风险。
我们在全州范围内的数据库中进行了一项基于人群的回顾性队列研究，纳入了 1996 年 1 月至 2013 年 12 月期间所有髋关节或膝关节初次全关节置换术的患者（n=85332）。我们排除了 9854 名年龄<18 岁、数据缺失、索引手术前有 PJI 病史或无 2 年随访证据（不包括有 PJI 的患者）的患者。将索引手术后发生 PJI 的患者（n=2282）与未发生 PJI 的患者（n=73196）进行比较。
在调整了协变量后，以医疗补助为主要支付方式的患者发生 PJI 的风险更高（相对风险 1.40，95%置信区间[CI]为 1.08-1.82，P=0.01）。在与教育程度或家庭收入中位数相关的组之间，风险没有差异（均 P>0.05）。PJI 患者的一级亲属（风险比 1.66，95%CI 为 1.23-2.24，P=0.001）和一级亲属和二级亲属（风险比 1.39，95%CI 为 1.09-1.77，P=0.007）的风险更高，尽管控制了上述社会经济因素。
我们的研究进一步支持遗传因素可能是 PJI 的基础，因为即使在考虑了社会经济因素和支付者身份后，我们确实观察到了显著的家族风险。我们没有发现教育程度或家庭收入与 PJI 之间存在相关性；然而，医疗补助的支付者风险增加。需要进一步研究以确定 PJI 的可能遗传性易感性，从而优化治疗并可能预防这种并发症。
