Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Berlin, Germany.
Bone Joint J. 2023 Feb;105-B(2):135-139. doi: 10.1302/0301-620X.105B2.BJJ-2022-1035.R1.
Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution.
We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and (9%). Two-stage exchange was performed in 30 joints and permanent resection arthroplasty in three. Kaplan-Meier survivorship analyses were performed. Mean follow-up was five years (3 to 7).
The two-year survivorship free of any recurrent PJI was 72% (95% confidence interval (CI) 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), one for the same pathogen as at index infection. One additional surgical site infection was noted at two weeks, resulting in a 69% (95% CI 52 to 86; 17 patients at risk) survivorship free of any infection at two years. There were two additional revisions for dislocations at one month each. As such, the two-year survivorship free of any revision was 61% (95% CI 42 to 80; 12 patients at risk). In addition to the aforementioned revisions, there was one additional skin grafting for a decubitus ulcer, resulting in a survivorship free of any reoperation of 54% (95% CI 35 to 73; ten patients at risk) at two years. Mean Clavien-Dindo score of perioperative complications was two out of five, with one case of perioperative death noted at six days.
Octogenarians undergoing surgery for PJI of the hip are at low risk of acute mortality, but are at moderate risk of other perioperative complications. One in two patients will undergo a reoperation within two years, with 70% attributable to recurrent infections.Cite this article: 2023;105-B(2):135-139.
老年人全髋关节置换术后发生假体周围关节感染（PJI）的情况并不少见，但目前对此类感染的研究还很有限。本研究分析了单所大学附属医院治疗 PJI 的 80 岁以上老年人的感染特征、手术结果和围手术期并发症。
我们使用机构关节登记处确定了 2010 年 1 月至 2019 年 12 月期间接受髋关节 PJI 治疗的 33 名患者。平均年龄为 82 岁（80-90 岁），女性 19 名（57%），平均 BMI 为 26kg/m（17-41）。平均美国麻醉医师协会（ASA）分级为 3 级（1-4 级），平均 Charlson 合并症指数为 6 分（4-10 分）。主要病原体包括凝固酶阴性葡萄球菌（45%）和金黄色葡萄球菌（9%）。30 个关节行两期置换，3 个关节行永久性切除关节成形术。进行 Kaplan-Meier 生存分析。平均随访 5 年（3-7 年）。
两年内无任何复发性 PJI 的生存率为 72%（95%置信区间 56-89%；18 名患者存在风险）。在平均 1 年（16 天至 8 年）时，共发生 9 例复发性 PJI，其中 1 例与初次感染的病原体相同。在两周时还发生了 1 例手术部位感染，导致两年内无任何感染的生存率为 69%（95%置信区间 52-86%；17 名患者存在风险）。还有 2 例髋关节脱位，分别在术后 1 个月行翻修。因此，两年内无任何翻修的生存率为 61%（95%置信区间 42-80%；12 名患者存在风险）。除了上述翻修外，还有 1 例因褥疮行皮肤移植，导致两年内无任何再次手术的生存率为 54%（95%置信区间 35-73%；10 名患者存在风险）。围手术期并发症的 Clavien-Dindo 评分平均为 2 分，5 分，有 1 例患者在术后 6 天死亡。
接受髋关节 PJI 手术的 80 岁以上老年人急性死亡率较低，但围手术期其他并发症的风险中等。大约每 2 名患者中就有 1 名将在两年内再次手术，其中 70%归因于复发性感染。
