From the Department of Orthopaedics and Rehabilitation, Penn State University College of Medicine, Hershey, PA (Dr. Kirchner, Dr. Kim, Dr. Nikkel), the Department of Orthopaedic Surgery, Mount Sinai School of Medicine, New York, NY (Dr. Lieber), the Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA (Dr. Kerbel), and the Philadelphia Veterans Affairs Hospital, University of Pennsylvania, Philadelphia, PA (Dr. Moretti).
J Am Acad Orthop Surg. 2021 May 15;29(10):439-445. doi: 10.5435/JAAOS-D-20-00686.
Girdlestone resection arthroplasty (GRA) is a radical but sometimes necessary treatment of periprosthetic joint infection (PJI) of the hip. The purpose of this of this study was to identify the independent risk factors for GRA after PJI of the hip.
This is a retrospective, cross-sectional analysis of the National (Nationwide) Inpatient Sample from 2010 to 2014. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used to identify 27,404 patients with PJI of the hip, including 889 patients who underwent GRA (ICD-9-CM 80.05). A multivariate model was created to examine the association between GRA and patient characteristics such as age, sex, race, primary payer, median household income, and location and teaching status of the hospital where the procedure was performed. Furthermore, the model controlled for patient comorbidities, including diabetes, anemias, hypertension, congestive heart failure, chronic pulmonary disease, peripheral vascular disease, and drug abuse.
The strongest independent risk factor for GRA was Medicare insurance (odds ratio [OR], 1.859, 95% confidence interval [CI], 1.500 to 2.304). Medicaid insurance was also associated with GRA (OR, 1.662, CI, 1.243 to 2.223). Compared with the wealthiest quartile for household income, patients in the poorest quartile (OR, 1.299, CI, 1.046 to 1.614) and second poorest quartile (OR, 1.269, CI, 1.027 to 1.567) were significantly more likely to have a GRA. Furthermore, patients older than 80 years old were at a higher risk of GRA than all other age groups (P < 0.05). No statistical differences were seen regarding patient race or sex.
This study demonstrates that poorer patients, patients with government health insurance plans, and elderly patients are each at independently heightened risk of undergoing a GRA for the treatment of PJI of the hip.
III, retrospective cohort study.
关节固定成形术（GRA）是一种根治性的治疗方法，但有时也是髋关节假体周围感染（PJI）的必要治疗手段。本研究的目的是确定髋关节 PJI 后接受 GRA 的独立危险因素。
这是一项回顾性、横断面分析，数据来自 2010 年至 2014 年全国（全国）住院患者样本。国际疾病分类，第 9 修订版，临床修正（ICD-9-CM）用于识别 27404 例髋关节 PJI 患者，其中 889 例患者接受了 GRA（ICD-9-CM 80.05）。建立了一个多变量模型来检查 GRA 与患者特征（如年龄、性别、种族、主要支付人、家庭收入中位数以及手术医院的位置和教学状态）之间的关联。此外，该模型还控制了患者合并症，包括糖尿病、贫血、高血压、充血性心力衰竭、慢性肺部疾病、外周血管疾病和药物滥用。
接受 GRA 的最强独立危险因素是医疗保险（优势比[OR]，1.859，95%置信区间[CI]，1.500 至 2.304）。医疗补助保险也与 GRA 相关（OR，1.662，CI，1.243 至 2.223）。与家庭收入最高的四分位数相比，收入最低的四分位数（OR，1.299，CI，1.046 至 1.614）和第二低的四分位数（OR，1.269，CI，1.027 至 1.567）的患者接受 GRA 的可能性明显更高。此外，80 岁以上的患者接受 GRA 的风险高于所有其他年龄组（P<0.05）。患者种族或性别方面无统计学差异。
本研究表明，较贫困的患者、有政府医疗保险计划的患者和老年患者在髋关节 PJI 治疗中接受 GRA 的风险均独立增加。
III，回顾性队列研究。
