Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany.
German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany.
J Arthroplasty. 2021 Mar;36(3):991-997. doi: 10.1016/j.arth.2020.09.011. Epub 2020 Sep 14.
Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA.
In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed.
In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group.
No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
人工关节感染（PJI）是导致短期翻修全膝关节置换术（TKA）最常见和最具破坏性的原因之一。体外证据表明陶瓷表面具有抗生物膜的能力，但表面改性对 PJI 风险的临床影响仍不清楚。这项基于注册的研究主要探讨了陶瓷轴承表面涂层对骨水泥固定初次 TKA 结果的影响。
自 2012 年以来，德国关节置换登记处共随访了 117660 例原发性骨关节炎患者的骨水泥固定初次 TKA，随访时间最长为 3 年。主要终点是陶瓷涂层和未涂层钴铬钼股骨部件的 PJI 翻修风险。对年龄、性别、肥胖、糖尿病、抑郁症和 Elixhauser 合并症指数进行倾向评分匹配，并对有涂层和无涂层的常见设计双胞胎进行分层。
共发现 4637 例（85.1%为女性）股骨部件有陶瓷涂层的 TKA，其中 42 例因 PJI 翻修，3 年时因其他原因翻修 122 例。陶瓷涂层部件不能确定因 PJI 翻修风险而具有生存优势。所有其他原因的翻修显示，陶瓷涂层部件的翻修率明显更高。然而，这一结果受到陶瓷涂层组金属敏感性（20.7%对 0.3%）的强烈流行率的影响。
在骨水泥固定初次 TKA 中，陶瓷涂层植入物并未发现降低 PJI 风险的证据。需要进一步分析除 PJI 以外的其他翻修原因。
