Tan Timothy L, Xu Chi, Kuo Feng-Chih, Ghanem Elie, George Jaiben, Shohat Noam, Chen Ji-Ying, Lee Mel S, Higuera Carlos, Parvizi Javad
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, Chinese PLA General Hospital (301 Hospital), Beijing, People's Republic of China.
JB JS Open Access. 2021 May 13;6(2). doi: 10.2106/JBJS.OA.20.00146. eCollection 2021 Apr-Jun.
Patients undergoing total joint arthroplasty (TJA) following septic arthritis are at higher risk for developing periprosthetic joint infection (PJI). Minimal literature is available to guide surgeons on the optimal timing of TJA after completing treatment for prior native joint septic arthritis. This multicenter study aimed to determine the optimal timing of TJA after prior septic arthritis and to examine the role of preoperative serology in predicting patients at risk for developing PJI.
A total of 207 TJAs were performed after prior septic arthritis from 2000 to 2017 at 5 institutions. Laboratory values, prior treatment, time from the initial infection, and other variables were recorded. Bivariate analyses were performed to identify the association between the time from septic arthritis to TJA and the risk of developing subsequent PJI. A subanalysis was performed between patients who underwent TJA in 1 setting (n = 97) compared with those who underwent 2-stage arthroplasties (n = 110). Receiver operating characteristic (ROC) curve analysis was performed for serum markers prior to TJA in predicting the risk of a subsequent PJI.
The overall PJI rate was 12.1%. Increasing time from septic arthritis treatment to TJA was not associated with a reduction of PJI, whether considering time as a continuous or categorical variable, for both surgical treatment cohorts (all p > 0.05). Although the ROC curve analysis found that the optimal threshold for timing of TJA from the initial treatment was 5.9 months, there was no difference in the PJI rate when the overall cohort was dichotomized by this threshold and when stratified by 1-stage compared with 2-stage TJA. There was no significant difference in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level prior to conversion TJA between patients who subsequently developed PJI and those who did not.
Serum markers have limited value in predicting subsequent PJI in patients who undergo TJA after prior septic arthritis. There was no optimal interim period between septic arthritis treatment and subsequent TJA; thus, delaying a surgical procedure does not appear to reduce the risk of PJI.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
脓毒性关节炎后接受全关节置换术（TJA）的患者发生假体周围关节感染（PJI）的风险更高。目前关于指导外科医生确定先前原生关节脓毒性关节炎治疗完成后进行TJA的最佳时机的文献很少。这项多中心研究旨在确定先前脓毒性关节炎后TJA的最佳时机，并探讨术前血清学在预测发生PJI风险患者中的作用。
2000年至2017年期间，5家机构对先前脓毒性关节炎患者进行了总共207例TJA手术。记录实验室检查值、先前治疗情况、从初次感染开始的时间以及其他变量。进行双变量分析以确定从脓毒性关节炎到TJA的时间与发生后续PJI风险之间的关联。对在1种情况下接受TJA的患者（n = 97）与接受两阶段关节置换术的患者（n = 110）进行了亚组分析。对TJA术前血清标志物进行受试者操作特征（ROC）曲线分析，以预测后续发生PJI的风险。
总体PJI发生率为12.1%。无论是将时间视为连续变量还是分类变量，对于两个手术治疗队列，从脓毒性关节炎治疗到TJA的时间增加与PJI风险降低均无关联（所有p>0.05）。尽管ROC曲线分析发现从初始治疗开始进行TJA的最佳时间阈值为5.9个月，但当根据该阈值将总体队列二分法划分以及按一期与二期TJA分层时，PJI发生率并无差异。在随后发生PJI的患者与未发生PJI的患者之间，转换TJA之前的红细胞沉降率（ESR）和C反应蛋白（CRP）水平无显著差异。
血清标志物在预测先前脓毒性关节炎后接受TJA患者发生后续PJI方面价值有限。脓毒性关节炎治疗与后续TJA之间没有最佳的间隔期；因此，延迟手术似乎并不能降低PJI风险。
预后III级。有关证据水平的完整描述，请参阅作者指南。
