Department of Orthopaedic Surgery, The University of Nebraska Medical Center, Omaha, NE.
J Arthroplasty. 2022 Jul;37(7S):S674-S677. doi: 10.1016/j.arth.2022.03.017. Epub 2022 Mar 11.
Two-stage reimplantation is an effective treatment for periprosthetic joint infection (PJI). Many factors are involved in the variable success of this procedure. The purpose of this study is to examine the relationship between patient risk factors, comorbidities, and the pathogen on reinfection rates following two-stage reimplantation.
We evaluated 158 patients treated for PJI from 2008-2019. Only patients who had completed a two-stage exchange were included. Patient demographics, comorbidities, laboratory values, time-to-reimplantation, pathogen, antibiotic sensitivities, host status, and reinfection rates were assessed. Multivariate analysis was performed to identify correlation between risk factors and reinfection. A P-value < .05 was considered statistically significant.
31 patients experienced a reinfection (19.6%). There was a statistically significant association between infection with Methicillin Sensitive Staphylococcus Aureus (MSSA) and reinfection (P = .046). Patients with a reinfection also had a significantly greater median serum C-reactive protein (CRP) level (12.65 g/dL) at the time of diagnosis compared to patients without a reinfection (5.0 g/dL) (P = .010). Median Erythrocyte Sedimentation Rate (ESR) (56 in no re-infection and 69 in re-infection) and time-to-reimplantation (101 days in no reinfection and 141 days in reinfection) demonstrated a trend toward an association with re-infection but were not statistically significant (P = .055 and P = .054 respectively).
As the number of arthroplasties continue to rise, PJIs are increasing proportionately and represent a significant revision burden. Elevated C-reactive protein (CRP) levels and Methicillin Sensitive Staphylococcus aureus (MSSA) infection were strongly associated with failure of a two-stage reimplantation. While not statistically significant with our numbers, there were strong trends toward an association between elevated Erythrocyte Sedimentation Rate (ESR), longer time-to-reimplantation, and reinfection.
两阶段再植入术是治疗假体周围关节感染（PJI）的有效方法。该手术的成功率受多种因素影响。本研究旨在探讨患者危险因素、合并症和病原体与两阶段再植入术后再感染率之间的关系。
我们评估了 2008 年至 2019 年间治疗的 158 例 PJI 患者。仅纳入完成两阶段置换的患者。评估患者人口统计学、合并症、实验室值、再植入时间、病原体、抗生素敏感性、宿主状态和再感染率。采用多变量分析确定危险因素与再感染之间的相关性。P 值<.05 被认为具有统计学意义。
31 例患者发生再感染（19.6%）。感染耐甲氧西林金黄色葡萄球菌（MSSA）与再感染有显著相关性（P=0.046）。与无再感染患者相比，发生再感染的患者在诊断时的血清 C 反应蛋白（CRP）水平中位数（12.65 g/dL）显著更高（5.0 g/dL）（P=0.010）。红细胞沉降率（ESR）中位数（无再感染时为 56，再感染时为 69）和再植入时间（无再感染时为 101 天，再感染时为 141 天）显示出与再感染相关的趋势，但无统计学意义（P=0.055 和 P=0.054）。
随着关节置换数量的不断增加，PJI 也相应增加，成为一个重大的翻修负担。CRP 水平升高和耐甲氧西林金黄色葡萄球菌（MSSA）感染与两阶段再植入失败密切相关。虽然我们的数字没有统计学意义，但 CRP 水平升高、再植入时间延长与再感染之间存在强烈的关联趋势。
