Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts.
J Arthroplasty. 2023 Jan;38(1):152-157. doi: 10.1016/j.arth.2022.07.018. Epub 2022 Aug 3.
The risk of periprosthetic joint infection (PJI) is higher in persons who inject drugs (PWID) after total joint arthroplasty (TJA), though reported rates vary widely. This study was designed to assess outcomes of TJA in PWID and to describe factors associated with improved PJI outcomes among PWID.
A retrospective matched cohort study was performed using a 1:4 match among those with and those without a history of injection drug use (IDU) undergoing TJA. Demographic, surgical, and outcome variables were compared in multivariate logistic regressions to determine PJI predictors. Kaplan-Meier analyses were constructed to characterize the difference in survival of patients who did not have PJI or undergo joint explantation between PWID and the matching cohort.
PWID had a 9-fold increased risk of PJI compared to the matched cohort (odds ratio 9.605, 95% CI 2.781-33.175, P < .001). Ten of 17 PWID whose last use was within 6 months (active use) of primary TJA had a PJI, while 7 of 41 PWID who did not have active use developed a PJI. Of PWID with PJI, treatment failure was seen in 15 of 17, while in patients who did not have an IDU history, 5 of 8 with PJI had treatment failure.
IDU is a significant risk factor for PJI following TJA. Future work investigating the effect of a multidisciplinary support team to assist in cessation of IDU and to provide social support may improve outcomes and reduce morbidity in this vulnerable population.
在接受全关节置换术 (TJA) 后，药物注射者 (PWID) 发生假体周围关节感染 (PJI) 的风险较高，尽管报告的发生率差异很大。本研究旨在评估 PWID 接受 TJA 的结果，并描述与 PWID 中 PJI 结果改善相关的因素。
使用接受 TJA 的有和没有药物注射史 (IDU) 的患者进行 1:4 匹配，进行回顾性匹配队列研究。使用多元逻辑回归比较人口统计学、手术和结果变量，以确定 PJI 的预测因素。构建 Kaplan-Meier 分析以描述 PWID 和匹配队列之间未发生 PJI 或关节取出的患者的生存差异。
与匹配队列相比，PWID 的 PJI 风险增加了 9 倍（优势比 9.605，95%置信区间 2.781-33.175，P<.001）。在 17 名 PWID 中，有 10 名患者的最后一次使用是在初次 TJA 前 6 个月内（活跃使用），发生了 PJI，而在没有活跃使用的 41 名 PWID 中，有 7 名发生了 PJI。在患有 PJI 的 PWID 中，有 15 例治疗失败，而在没有 IDU 病史的患者中，有 5 例 PJI 患者治疗失败。
IDU 是 TJA 后 PJI 的一个重要危险因素。未来的研究调查多学科支持团队的效果，以协助停止 IDU 并提供社会支持，可能会改善这一脆弱人群的结果并降低发病率。
