Hotchen Andrew James, Wismayer Martina Galea, Robertson-Waters Eve, McDonnell Stephen M, Kendrick Ben, Taylor Adrian, Alvand Abtin, McNally Martin
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 7HE, United Kingdom.
Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals, Cambridge, United Kingdom.
EClinicalMedicine. 2021 Nov 6;42:101192. doi: 10.1016/j.eclinm.2021.101192. eCollection 2021 Dec.
There is currently no commonly accepted method of stratifying complexity of prosthetic joint infection (PJI). This study assesses a new classification, the Joint-Specific, Bone involvement, Anti-microbial options, Coverage of the soft tissues, Host status (JS-BACH) classification, for predicting clinical and patient reported outcomes in PJI.
Patients who received surgery for PJI at two centres in the UK between 2010 and 2015 were classified using JS-BACH as 'uncomplicated', 'complex' or 'limited treatment options'. Patient reported outcomes were recorded at 365-days following the index operation and included the EuroQol EQ-5D-3L index score and the EQ-visual analogue score (VAS). Clinical outcome data were obtained from the most recent follow-up appointment.
220 patients met the inclusion criteria. At 365-days following the index operation, patients with 'uncomplicated' PJI reported similar EQ-index scores (0.730, SD:0.326) and EQ-VAS (79.4, SD:20.9) compared to the age-matched population. Scores for 'uncomplicated' PJI were significantly higher than patients classified as having 'complex' (EQ-index:0.515 SD:0.323, = 0.012; EQ-VAS:68.4 SD:19.4, = 0.042) and 'limited treatment options' PJI (EQ-index:0.333 SD:0.383, < 0.001; EQ-VAS:60.2, SD:23.1, = 0.005). The median time to final follow-up was 4.7 years (inter-quartile range 2.7-6.7 years) where there were 74 cases (33.6%) of confirmed recurrence. Using death as a competing risk, the Cox proportional-hazards ratio of recurrence for 'complex' versus 'uncomplicated' PJI was 23.7 (95% CI:3.23-174.0, = 0.002) and having 'limited options' verses 'uncomplicated' PJI was 57.7 (95% CI:7.66-433.9, < 0.001).
The JS-BACH classification can help predict likelihood of recurrence and quality of life following surgery for PJI. This will aid clinicians in sharing prognostic information with patients and help guide referral for specialist management of PJI.
目前尚无普遍接受的人工关节感染（PJI）复杂性分层方法。本研究评估一种新的分类方法，即关节特异性、骨受累情况、抗菌药物选择、软组织覆盖范围、宿主状态（JS-BACH）分类，用于预测PJI的临床和患者报告结局。
2010年至2015年期间在英国两个中心接受PJI手术的患者，使用JS-BACH分类为“非复杂性”、“复杂性”或“治疗选择有限”。在首次手术365天后记录患者报告结局，包括欧洲五维健康量表（EQ-5D-3L）指数评分和EQ视觉模拟评分（VAS）。临床结局数据来自最近的随访预约。
220例患者符合纳入标准。在首次手术365天后，“非复杂性”PJI患者报告的EQ指数评分（0.730，标准差：0.326）和EQ-VAS（79.4，标准差：20.9）与年龄匹配人群相似。“非复杂性”PJI的评分显著高于分类为“复杂性”（EQ指数：0.515，标准差：0.323，P = 0.012；EQ-VAS：68.4，标准差：19.4，P = 0.042）和“治疗选择有限”的PJI患者（EQ指数：0.333，标准差：0.383，P < 0.001；EQ-VAS：60.2，标准差：23.1，P = 0.005）。最终随访的中位时间为4.7年（四分位间距2.7 - 6.7年），其中有74例（33.6%）确诊复发。以死亡作为竞争风险，“复杂性”与“非复杂性”PJI复发的Cox比例风险比为23.7（95%置信区间：3.23 - 174.0，P = 0.002），“治疗选择有限”与“非复杂性”PJI的风险比为57.7（95%置信区间：7.66 - 433.9，P < 0.001）。
JS-BACH分类有助于预测PJI手术后的复发可能性和生活质量。这将有助于临床医生与患者分享预后信息，并帮助指导PJI专科管理的转诊。
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