Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2023 Jun;38(6S):S345-S349. doi: 10.1016/j.arth.2023.02.041. Epub 2023 Feb 23.
Patients undergoing total knee arthroplasty (TKA) are at increased risk of venous thromboembolism (VTE). Aspirin has been shown to be effective at reducing rates of VTE. In select patients, more potent thromboprophylaxis is indicated, which has been associated with increased rates of bleeding and wound complications. This study aimed to evaluate the effect of thromboprophylaxis choice on the rates of early prosthetic joint infection (PJI) following TKA.
A review of 11,547 primary TKA patients from 2013 to 2019 at a single academic orthopaedic hospital was conducted. The primary outcome measure was PJI within 90 days of surgery as measured by Musculoskeletal Infection Society criteria. There were 59 (0.5%) patients diagnosed with early PJI. Chi-square and Welch-2 sample t-tests were used to determine statistically significant relationships between thromboprophylaxis and demographic variables. Significance was set at P < .05. Multivariate logistic regression adjusted for age, body mass index, sex, and Charlson comorbidity index was performed to identify and control for independent risk factors for early PJI.
There was a statistically significant difference in the rates of early PJI between the aspirin and non-aspirin group (0.3 versus 0.8%, P < .001). Multivariate logistic regressions revealed that patients given aspirin thromboprophylaxis had significantly lower odds of PJI (odds ratios = 0.51, 95% confidence interval = 0.29-0.89, P = .019) compared to non-aspirin patients.
The use of aspirin thromboprophylaxis following primary TKA is independently associated with a lower rate of early PJIs. Arthroplasty surgeons should consider aspirin as the gold standard thromboprophylaxis in all patients in which it is deemed medically appropriate and should carefully weigh the morbidity of PJI in patients when non-aspirin thromboprophylaxis is considered.
Retrospective, Therapeutic Level III.
接受全膝关节置换术（TKA）的患者发生静脉血栓栓塞（VTE）的风险增加。阿司匹林已被证明可有效降低 VTE 发生率。在选择的患者中，需要更有效的血栓预防，这与增加出血和伤口并发症的发生率有关。本研究旨在评估血栓预防选择对 TKA 后早期人工关节感染（PJI）发生率的影响。
对 2013 年至 2019 年在一家学术骨科医院接受初次 TKA 的 11547 例患者进行了回顾性研究。主要结局测量指标是按照肌肉骨骼感染学会（Musculoskeletal Infection Society）标准测量的术后 90 天内的 PJI。59 例（0.5%）患者被诊断为早期 PJI。使用卡方检验和 Welch-2 样本 t 检验来确定血栓预防与人口统计学变量之间存在统计学显著关系。设定显著性水平为 P<.05。采用多元逻辑回归分析，调整年龄、体重指数、性别和 Charlson 合并症指数，以确定和控制早期 PJI 的独立危险因素。
阿司匹林组和非阿司匹林组的早期 PJI 发生率存在统计学显著差异（0.3%比 0.8%，P<.001）。多元逻辑回归分析显示，接受阿司匹林血栓预防的患者发生 PJI 的可能性显著降低（比值比=0.51，95%置信区间=0.29-0.89，P=0.019）。
初次 TKA 后使用阿司匹林血栓预防与早期 PJI 发生率较低独立相关。关节置换外科医生应考虑在所有医学上合适的患者中使用阿司匹林作为金标准血栓预防，并在考虑非阿司匹林血栓预防时，仔细权衡患者 PJI 的发病率。
回顾性，治疗 III 级。
