Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5405-5415. doi: 10.1007/s00402-022-04756-z. Epub 2023 Jan 11.
Increased risk of periprosthetic joint infection (PJI) in minimally invasive (MIS) total hip arthroplasty (THA) is still debated. This study aimed to identify differences in surgical and patient-related risk factors for PJI between an MIS anterolateral approach and transgluteal-modified Hardinge approach.
A retrospective cohort of 5315 THAs performed between 2006 and 2019 at a single institution was screened. Short stem THAs performed via an MIS anterolateral approach in the supine position and standard straight stem THAs performed via a transgluteal modified Hardinge approach were included. Propensity score matching was performed to control for selection bias. After matching, 1405 (34.3%) short stem THAs implanted via MIS anterolateral approach and 2687 (65.7%) straight stem THAs implanted via a transgluteal modified Hardinge approach were included. The risk of PJI due to patient-specific and surgical factors was retrospectively analyzed using chi-square test and multivariate regression analysis.
PJI occurred in 1.1% in both MIS anterolateral and transgluteal approach (p = 0.823). Multivariate regression showed an increased infection risk for patients with a BMI between 35 and 39.99 kg/m (OR 6.696; CI 1.799-24.923; p = 0.005), which could not be demonstrated for transgluteal approach (OR 0.900; CI 0.900-4.144; p = 0.93). A BMI ≥ 40 kg/m (OR 14.150; CI 2.416-82.879; p = 0.003) was detected as a risk factor for PJI only in anterolateral approach. Increased operation time ≥ 121 min showed a significantly increased risk for PJI in the general cohort (OR 6.989; CI1.286-37.972; p = 0.024).
Minimally invasive anterolateral and transgluteal THA show a comparable rate of early PJI within the first year of index surgery. A BMI of ≥ 35 kg/m was detected as a clear risk factor for infection in the anterolateral approach. Prolonged operation time ≥ 121 min increases the risk of PJI regardless of approach.
微创全髋关节置换术（THA）中假体周围关节感染（PJI）风险增加仍存在争议。本研究旨在确定微创前路和改良经臀后路 Hardinge 入路在手术和患者相关 PJI 危险因素方面的差异。
对 2006 年至 2019 年在一家单中心进行的 5315 例 THA 进行回顾性队列筛查。纳入了采用微创前路仰卧位短柄 THA 和改良经臀后路 Hardinge 直柄 THA。采用倾向评分匹配来控制选择偏倚。匹配后，纳入 1405 例（34.3%）采用微创前路短柄 THA 和 2687 例（65.7%）采用改良经臀后路 Hardinge 直柄 THA。采用卡方检验和多因素回归分析回顾性分析患者特定和手术因素导致 PJI 的风险。
微创前路和改良经臀后路的 PJI 发生率分别为 1.1%（p=0.823）。多因素回归显示 BMI 在 35 至 39.99kg/m2 之间的患者感染风险增加（OR 6.696；95%CI 1.799-24.923；p=0.005），而改良经臀后路未发现（OR 0.900；95%CI 0.900-4.144；p=0.93）。仅在微创前路中，BMI≥40kg/m2（OR 14.150；95%CI 2.416-82.879；p=0.003）被确定为 PJI 的危险因素。手术时间≥121 分钟的患者发生 PJI 的风险显著增加（OR 6.989；95%CI 1.286-37.972；p=0.024）。
微创前路和改良经臀后路 THA 在索引手术的第一年早期 PJI 发生率相当。BMI≥35kg/m2 被确定为微创前路感染的明确危险因素。手术时间延长≥121 分钟会增加 PJI 的风险，与手术入路无关。
