Jensen Marie L, Jensen Steen L, Bolder Matthijs, Hanisch Klaus W J, Sørensen Anne Kathrine B, Olsen Bo S, Falstie-Jensen Thomas, Rasmussen Jeppe V
Copenhagen University Hospital, Gentofte, Denmark.
Aalborg University Hospital, Farsø, Denmark.
J Shoulder Elbow Surg. 2023 Jan;32(1):111-120. doi: 10.1016/j.jse.2022.07.001. Epub 2022 Aug 14.
Previous studies have indicated an increased risk of periprosthetic joint infection (PJI) in patients treated with reverse shoulder arthroplasty (RSA) compared with patients treated with anatomic total shoulder arthroplasty. The reason for this is unclear but may be related to a high prevalence of previous rotator cuff repair in patients who are treated with RSA. The purpose of this study was to determine previous non-arthroplasty surgery as a risk factor for revision owing to PJI after RSA for cuff tear arthropathy, massive irreparable rotator cuff tears, or osteoarthritis.
Data were retrieved from the Danish Shoulder Arthroplasty Registry and medical records. We included 2217 patients who underwent RSA for cuff tear arthropathy, massive irreparable rotator cuff tears, or osteoarthritis between 2006 and 2019. PJI was defined as ≥3 of 5 tissue samples positive for the same bacteria or as definite or probable PJI evaluated based on criteria from the International Consensus Meeting. The Kaplan-Meier method was used to illustrate the unadjusted 14-year cumulative rates of revision. A Cox regression model was used to report hazard for revision owing to PJI. Results were adjusted for previous non-arthroplasty surgery, sex, diagnosis, and age.
Revision was performed in 88 shoulders (4.0%), of which 40 (1.8%) underwent revision owing to PJI. There were 272 patients (12.3%) who underwent previous rotator cuff repair, of whom 11 (4.0%) underwent revision owing to PJI. The 14-year cumulative rate of revision owing to PJI was 14.1% for patients with previous rotator cuff repair and 2.7% for patients without previous surgery. The adjusted hazard ratio for revision owing to PJI for patients with previous rotator cuff repair was 2.2 (95% confidence interval, 1.04-4.60) compared with patients without previous surgery.
There is an increased risk of revision owing to PJI after RSA for patients with previous rotator cuff repair. We recommend that patients with previous rotator cuff repair be regarded as high-risk patients when considering RSA.
先前的研究表明，与接受解剖型全肩关节置换术的患者相比，接受反肩关节置换术（RSA）的患者发生假体周围关节感染（PJI）的风险增加。其原因尚不清楚，但可能与接受RSA治疗的患者既往肩袖修复的高发生率有关。本研究的目的是确定既往非关节置换手术作为RSA治疗肩袖撕裂性关节病、巨大不可修复肩袖撕裂或骨关节炎后因PJI进行翻修的危险因素。
从丹麦肩关节置换登记处和医疗记录中检索数据。我们纳入了2006年至2019年间因肩袖撕裂性关节病、巨大不可修复肩袖撕裂或骨关节炎接受RSA的2217例患者。PJI定义为5个组织样本中≥3个对同一细菌呈阳性，或根据国际共识会议的标准评估为确诊或可能的PJI。采用Kaplan-Meier方法说明未经调整的14年翻修累积率。采用Cox回归模型报告因PJI进行翻修的风险。结果根据既往非关节置换手术、性别、诊断和年龄进行了调整。
88例（4.0%）肩关节进行了翻修，其中40例（1.8%）因PJI进行了翻修。有272例患者（12.3%）既往接受过肩袖修复，其中11例（4.0%）因PJI进行了翻修。既往接受过肩袖修复的患者因PJI进行翻修的14年累积率为14.1%，未接受过手术的患者为2.7%。与未接受过手术的患者相比，既往接受过肩袖修复的患者因PJI进行翻修的调整后风险比为2.2（95%置信区间，1.04-4.60）。
既往接受过肩袖修复的患者在RSA后因PJI进行翻修有更高的风险。我们建议在考虑RSA时，将既往接受过肩袖修复的患者视为高危患者。
