Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2023 Jun;32(6S):S1-S7. doi: 10.1016/j.jse.2023.02.004. Epub 2023 Feb 18.
Periprosthetic joint infections (PJIs) are a catastrophic complication after shoulder arthroplasty and may be associated with an increased mortality risk, as seen in hip and knee arthroplasty. Shoulder PJI organisms differ from hip and knee infections, as lower-virulence organisms, such as Cutibacterium acnes, are more commonly encountered. This study evaluated the association between shoulder PJI and mortality.
We retrospectively identified 411 patients who underwent revision shoulder arthroplasty from 2007 to 2020 at a single institution. 2018 International Consensus Meeting on Musculoskeletal Infection criteria were used to categorize each case as definite, probable, possible, or unlikely PJI. Mortality rate was assessed by performing chart reviews and an obituary search. Revision cases were grouped into a septic cohort (definite and probable PJI) and an aseptic cohort (possible and unlikely PJI). Kaplan-Meier analyses were performed to compare survival between septic and aseptic groups. The log-rank test was used to compare cumulative survival distributions and survival rates at 90 days, 6 months, 1 year, 2 years, and 5 years. Demographic information, Charlson Comorbidity Index (CCI), and culture data were collected. PJI organisms were categorized as virulent or nonvirulent per an infectious disease specialist, and predictors of mortality were determined by performing stepwise logistic regression analyses.
The overall mortality rate was significantly greater (P < .001) in the septic group (20.5%) than in the aseptic group (6.6%). When evaluating time from revision surgery to death, patients with PJI had significantly greater mortality compared with those undergoing aseptic revision at 2 years (7.7% vs. 2.1%, P = .01) and 5 years (17% vs. 5.1%, P < .001). Body mass index, CCI, race, sex, and age were not significantly different between groups. Groups differed in utilization of 2-staged procedures (65% septic, 9% aseptic, P < .001). Multivariate regression analysis found that the variables most associated with mortality were septic revision, 2-staged procedures, and CCI. In the septic group, patients with C acnes PJI had a significantly lower mortality rate when compared to PJI from any other offending organism (3.1% vs. 48.4%, P = .001).
Revision shoulder arthroplasty in the setting of PJI not only carries severe functional consequences for patients but is also associated with an increased mortality risk. Furthermore, C acnes infections are associated with a more favorable survival profile than PJI resulting from other organisms. Continued efforts to decrease shoulder arthroplasty infection rates are warranted and may influence long-term survival.
肩关节炎置换术后发生假体周围关节感染（PJI）是灾难性的并发症，其与髋膝关节置换术后一样，可能会增加死亡风险。肩 PJI 病原体与髋关节和膝关节感染不同，更常见的是低毒力病原体，如痤疮丙酸杆菌。本研究评估了肩 PJI 与死亡率之间的关系。
我们回顾性地在一家医疗机构确定了 2007 年至 2020 年间进行的 411 例翻修肩关节炎置换术患者。使用 2018 年国际肌肉骨骼感染共识会议标准对每个病例进行分类，确定为明确、可能、可能或不太可能的 PJI。通过进行图表审查和死亡公告搜索来评估死亡率。将翻修病例分为脓毒症组（明确和可能的 PJI）和无菌组（可能和不太可能的 PJI）。采用 Kaplan-Meier 分析比较两组之间的生存情况。采用对数秩检验比较累积生存分布和 90 天、6 个月、1 年、2 年和 5 年的生存率。收集人口统计学信息、Charlson 合并症指数（CCI）和培养数据。根据传染病专家的意见，将 PJI 病原体分类为毒力或非毒力病原体，并通过逐步逻辑回归分析确定死亡率的预测因素。
脓毒症组的总死亡率显著更高（P<.001）（20.5%），而非无菌组（6.6%）。评估从翻修手术到死亡的时间时，与进行无菌翻修的患者相比，PJI 患者在 2 年（7.7%比 2.1%，P=.01）和 5 年（17%比 5.1%，P<.001）时的死亡率显著更高。两组之间的体重指数、CCI、种族、性别和年龄无显著差异。两组在 2 期手术的使用上存在差异（脓毒症组 65%，无菌组 9%，P<.001）。多变量回归分析发现，与死亡率最相关的变量是脓毒症翻修、2 期手术和 CCI。在脓毒症组中，与其他致病病原体相比，痤疮丙酸杆菌 PJI 患者的死亡率明显更低（3.1%比 48.4%，P=.001）。
肩关节炎置换术治疗 PJI 不仅会给患者带来严重的功能后果，而且还会增加死亡风险。此外，与其他病原体引起的 PJI 相比，痤疮丙酸杆菌感染与更有利的生存情况相关。需要继续努力降低肩关节炎置换术感染率，这可能会影响长期生存。
