Linnaeus University, Faculty of health and Life Sciences, Universitetsplatsen 1, 352 32, Vaxjo, Sweden.
Swedish Joint Arthroplasty Register, Gothenburg, Sweden.
BMC Musculoskelet Disord. 2022 Mar 23;23(1):275. doi: 10.1186/s12891-022-05209-9.
In Sweden, the incidence of a prosthetic joint infection (PJI) after a planned Total Hip Arthroplasty (THA) is 1.3%, but the worldwide incidence of PJI after THA is unknown. This study explores associations between reoperation due to PJI and potential risk factors.
Primary elective THA surgery registered in both the Swedish Hip Arthroplasty Registry (SHAR) and the Swedish Perioperative Registry (SPOR) between 1 January 2015 and 31 December 2019 were included in this registry study, resulting in a total study population of 35,056 cases. The outcome variable was reoperation as the result of PJI within a year after surgery. Data were analysed using a multivariable Cox regression model.
Reoperation due to PJI occurred in 460 cases (i.e., 1.3% of the study population). Each year of age increased the risk with 2% (HR 1.02 Cl 1.01, 1.03 P = < 0.001). Compared to men, women had significantly less risk for reoperation (HR 2.17 Cl 1.79, 2.53 P = < 0.001). For patients with obesity (BMI > 30), the risk increased considerably compared to underweight, normal weight, or overweight patients (HR 1.89 Cl 1.43, 2.51 P = < 0.001). The risk also increased by 6% for every 10 min of operative time (HR 1.06 Cl 1.02, 1.09 P = < 0.001). Patients having general anaesthesia had greater risk compared to those with spinal anaesthesia (HR 1.34 Cl 1.04, 1.73 P = 0.024). Finally, a lateral approach showed higher risk of reoperation than a posterior approach (HR 1.43 Cl 1.18, 1.73 P = < 0.001).
Recognition of the several risk factors identified in this study will be important for the perioperative management of patients undergoing THA.
在瑞典，计划行全髋关节置换术（THA）后发生假体关节感染（PJI）的发病率为 1.3%，但全球范围内 THA 后 PJI 的发病率尚不清楚。本研究探讨了 PJI 再手术与潜在危险因素之间的关系。
本研究纳入了 2015 年 1 月 1 日至 2019 年 12 月 31 日期间在瑞典髋关节置换登记处（SHAR）和瑞典围手术期登记处（SPOR）中登记的原发性择期 THA 手术，总计 35056 例患者。主要结局为术后 1 年内因 PJI 而再次手术。采用多变量 Cox 回归模型进行数据分析。
460 例（即研究人群的 1.3%）患者因 PJI 而再次手术。年龄每增加 1 岁，风险增加 2%（HR 1.02，95%CI 1.01，1.03，P<0.001）。与男性相比，女性再次手术的风险显著降低（HR 2.17，95%CI 1.79，2.53，P<0.001）。与体重过低、正常体重或超重患者相比，肥胖（BMI>30）患者的风险显著增加（HR 1.89，95%CI 1.43，2.51，P<0.001）。手术时间每增加 10 分钟，风险增加 6%（HR 1.06，95%CI 1.02，1.09，P<0.001）。与椎管内麻醉相比，全身麻醉患者的风险更高（HR 1.34，95%CI 1.04，1.73，P=0.024）。最后，与后路入路相比，外侧入路的再手术风险更高（HR 1.43，95%CI 1.18，1.73，P<0.001）。
本研究确定的几个危险因素对于接受 THA 的患者的围手术期管理非常重要。
