Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital), Beijing, China.
J Arthroplasty. 2021 Mar;36(3):892-896. doi: 10.1016/j.arth.2020.09.020. Epub 2020 Sep 17.
Patients with native joint septic arthritis are one of the highest risk groups for developing complications following total joint arthroplasty (TJA), especially periprosthetic joint infection(PJI). There is a paucity of information on the risk factors for developing PJI and the optimal treatment modality of the native septic joint that can mitigate that risk. This multicenter study aimed to determine these risk factors, including prior treatment.
A retrospective study of 233 TJAs performed, following prior septic arthritis at five institutions, was conducted. Comorbidities, organism profile, prior surgery, etiology of septic arthritis, and other relevant variables were reviewed. The primary outcome was the development of PJI, defined by Musculoskeletal Infection Society criteria. Bivariate and multivariate analyses were performed to identify risk factors for PJI.
Overall, the PJI rate was 12.4% in patients who underwent TJA after native septic arthritis. Predisposing risk factors for PJI included antibiotic-resistant organisms, male gender, diabetes, and a postsurgical cause of septic arthritis eg open reduction internal fixation. When controlling for potential confounders, multivariate analysis revealed that male gender, diabetes, and a postoperative etiology were predictors of PJI. The definitive treatment modality for the septic joint did not affect the rate of PJI for both arthroscopy vs irrigation and debridement (I&D), and two-stage exchange vs single-stage procedure.
This study has identified several risk factors for developing PJI in patients with prior septic joint arthritis, some of which are modifiable. The initial treatment modality of the native septic joint has no bearing on the development of PJI after TJA.
患有原发性关节脓毒性关节炎的患者是全关节置换术（TJA）后发生并发症的最高风险人群之一，尤其是假体周围关节感染（PJI）。关于发展为 PJI 的危险因素以及可以降低该风险的原发性脓毒性关节的最佳治疗方式，相关信息有限。这项多中心研究旨在确定这些危险因素，包括既往治疗。
对五家机构进行的 233 例 TJA 进行了回顾性研究，这些 TJA 均继发于原发性脓毒性关节炎。对合并症、病原体特征、既往手术、脓毒性关节炎病因和其他相关变量进行了回顾。主要结局是采用肌肉骨骼感染学会标准定义的 PJI 的发生。进行了单变量和多变量分析以确定 PJI 的危险因素。
总体而言，在因原发性脓毒性关节炎而行 TJA 的患者中，PJI 发生率为 12.4%。PJI 的易患危险因素包括抗生素耐药病原体、男性、糖尿病和手术后的脓毒性关节炎病因，例如切开复位内固定。在控制潜在混杂因素后，多变量分析显示，男性、糖尿病和术后病因是 PJI 的预测因素。对于脓毒性关节，关节镜下灌洗和清创术（I&D）与二期翻修术相比一期翻修术，其初始治疗方式并不会影响 PJI 的发生率。
本研究确定了既往脓毒性关节炎患者发生 PJI 的一些危险因素，其中一些是可以改变的。原发性脓毒性关节炎的初始治疗方式与 TJA 后发生 PJI 无关。
