Orthopedics. 2021 May-Jun;44(3):e385-e389. doi: 10.3928/01477447-20210414-10. Epub 2021 May 1.
Debridement, antibiotics with implant retention (DAIR), and 2-stage revision are standard surgical interventions for treating knee periprosthetic joint infection (PJI). Patients with substance use disorder (SUD), especially addictive drug use disorder (DUD), have been shown to receive inferior medical care in many specialties compared with nonusers. The authors identified patients with a diagnosis of PJI after knee arthroplasty who received either DAIR or 2-stage revision with the Nationwide Inpatient Sample (NIS) database from 2010 to 2014. Patients were stratified into 2 groups, patients with DUD and nonusers, based on 5th Edition, criteria. Descriptive analysis was conducted to show the national trend for knee PJI treatment among the 2 patient groups. Multivariate logistic regression was used to compare the prevalence of DAIR and 2-stage revision between these 2 groups, adjusted for likely confounders, including age, sex, income, race, and comorbidities. Among the 11,331 patients with knee infection, 139 (1.23%) had DUD. Compared with nonusers, patients with DUD were significantly younger (<.001), had more chronic conditions (<.001), and were predominantly in lower income quartiles (=.046). The 2 groups did not differ in sex and race (=.072 and =.091, respectively). The authors found that 30.22% of patients with DUD and 36.36% of nonusers received DAIR. The difference in these proportions was not statistically significant (=.135). The results did not change after adjustment for confounding factors (=.509). The findings suggested that bias does not exist among orthopedic surgeons who choose DAIR or 2-stage revision for knee PJI among patients with DUD. [. 2021;44(3):e385-e389.].
清创术、保留植入物的抗生素治疗（DAIR）和 2 期翻修是治疗膝关节假体周围关节感染（PJI）的标准手术干预措施。有物质使用障碍（SUD）的患者，尤其是成瘾性药物使用障碍（DUD），与非使用者相比，在许多专业领域的医疗护理质量都较差。作者使用 2010 年至 2014 年全国住院患者样本（NIS）数据库，确定了膝关节置换术后诊断为 PJI 的患者，他们接受了 DAIR 或 2 期翻修。根据第 5 版标准，患者分为 DUD 组和非使用者组。进行描述性分析以显示这 2 组患者的全国膝关节 PJI 治疗趋势。使用多变量逻辑回归比较这 2 组患者之间 DAIR 和 2 期翻修的发生率，调整了可能的混杂因素，包括年龄、性别、收入、种族和合并症。在 11331 例膝关节感染患者中，有 139 例（1.23%）患有 DUD。与非使用者相比，DUD 患者明显更年轻（<.001），患有更多的慢性疾病（<.001），并且主要集中在较低的收入四分位数（=.046）。2 组患者在性别和种族方面没有差异（分别为=.072 和 =.091）。作者发现，DUD 患者中有 30.22%和非使用者中有 36.36%接受了 DAIR。这两个比例的差异没有统计学意义（=.135）。在调整混杂因素后，结果没有改变（=.509）。研究结果表明，在 DUD 患者中，骨科医生在选择 DAIR 或 2 期翻修治疗膝关节 PJI 时没有偏见。[J Bone Joint Surg Am. 2021;44(3):e385-e389.]。
