Faculty of Medical and Health Science, University of Auckland, Grafton, Auckland, New Zealand.
Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2587-2594. doi: 10.1007/s00590-023-03477-2. Epub 2023 Jan 29.
Septic arthritis of the native hip joint (SANH) is an uncommon surgical and medical emergency with few reports. The aim of this study was to determine predictors of return to theatre (RTT), complications and mortality.
Patients with SANH were identified from January 2009 to June 2022; 50 patients and three subgroups were identified: Pyogenic (surgical washout without systemic inflammatory disease), Systemic (surgical washout with SIDs) and patients managed non-surgically. Patterns of these groups were assessed with a principal component analysis. The cumulative incidences for death, any complication and RTT for repeat washout were calculated. The predictive variables associated with outcomes were selected with univariable models and then incorporated in multivariable CoxPH regressions.
The 1-year cumulative incidence was 14% for mortality and 48.5% for any complication. Amongst patients managed surgically, 1-year risk of RTT was 46% in Pyogenic subgroup and 21% in Systemic subgroup. Systemic subgroup had lower complications and RTT and higher rate of sterile aspirate, compared to Pyogenic. Charlson comorbidity index (CCI) (HR = 1.41, P value = 0.03), preoperative albumin (HR = 0.81, P value = 0.009) and preoperative haemoglobin (HR = 0.95, P value = 0.02) were significantly associated with 1-year mortality. Time between symptom onset and admission > 7 days (HR = 3.15, P value = 0.042), preoperative Hb (HR = 1.05, P value = 0.016), socioeconomic deprivation (HR = 1.18, P value = 0.04) and Systemic subgroup (HR = 0.25, P value = 0.04) were significantly associated with RTT.
Mortality was well predicted by the usual parameters including CCI, albumin, but also low haemoglobin. Patients presenting in a delayed fashion were more likely to have multiple lavages.
原发性髋关节化脓性关节炎（SANH）是一种罕见的外科和医学急症，相关报道较少。本研究旨在确定需要再次手术（RTT）、并发症和死亡率的预测因素。
从 2009 年 1 月至 2022 年 6 月，我们对患有 SANH 的患者进行了识别；确定了 50 名患者和三个亚组：化脓性（无全身炎症性疾病的手术冲洗）、全身性（有全身炎症性疾病的手术冲洗）和非手术治疗的患者。使用主成分分析评估这些组的模式。计算了死亡、任何并发症和因重复冲洗而需要 RTT 的累积发生率。使用单变量模型选择与结果相关的预测变量，然后将其纳入多变量 CoxPH 回归。
1 年时死亡率的累积发生率为 14%，任何并发症的累积发生率为 48.5%。在接受手术治疗的患者中，化脓亚组的 1 年 RTT 风险为 46%，全身性亚组的风险为 21%。与化脓性亚组相比，全身性亚组的并发症和 RTT 发生率较低，无菌性抽吸物的发生率较高。Charlson 合并症指数（CCI）（HR=1.41，P 值=0.03）、术前白蛋白（HR=0.81，P 值=0.009）和术前血红蛋白（HR=0.95，P 值=0.02）与 1 年死亡率显著相关。症状出现至入院时间>7 天（HR=3.15，P 值=0.042）、术前 Hb（HR=1.05，P 值=0.016）、社会经济剥夺（HR=1.18，P 值=0.04）和全身性亚组（HR=0.25，P 值=0.04）与 RTT 显著相关。
死亡率可通过 CCI、白蛋白等常用参数和低血红蛋白良好预测。发病时间延迟的患者更有可能需要多次冲洗。
