患者在接受多次髋关节和膝关节置换术后发生的单发性、复发性、同期性和异时性假体周围关节感染。
Single, Recurrent, Synchronous, and Metachronous Periprosthetic Joint Infections in Patients With Multiple Hip and Knee Arthroplasties.
机构信息
Department of Orthopaedic Surgery, Stanford University, Redwood City, California; Stanford University School of Medicine, Stanford, California.
Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
出版信息
J Arthroplasty. 2023 Sep;38(9):1846-1853. doi: 10.1016/j.arth.2023.03.014. Epub 2023 Mar 14.
BACKGROUND
The rate for periprosthetic joint infection (PJI) exceeds 1% for primary arthroplasties. Over 30% of patients who have a primary arthroplasty require an additional arthroplasty, and the impact of PJI on this population is understudied. Our objective was to assess the prevalence of recurrent, synchronous, and metachronous PJI in patients who had multiple arthroplasties and to identify risk factors for a subsequent PJI.
METHODS
We identified 337 patients who had multiple arthroplasties and at least 1 PJI that presented between 2003 and 2021. The mean follow-up after revision arthroplasty was 3 years (range, 0 to 17.2). Patients who had multiple infected prostheses were categorized as synchronous (ie, presenting at the same time as the initial infection) or metachronous (ie, presenting at a different time as the initial infection). The PJI diagnosis was made using the MusculoSkeletal Infection Society (MSIS) criteria.
RESULTS
There were 39 (12%) patients who experienced recurrent PJI in the same joint, while 31 (9%) patients developed PJI in another joint. Positive blood cultures were more likely in the second joint PJI (48%) compared to recurrent PJI (23%) or a single PJI (15%, P < .001). Synchronous PJI represented 42% of the second joint PJI cases (n = 13), while metachronous PJI represented 58% (n = 18). Tobacco users had 75% higher odds of metachronous PJI (odds ratio 1.75, 95% confidence interval: 1.1-2.9, P = .041).
CONCLUSION
Over 20% of the patients with multiple arthroplasties and a single PJI will develop a subsequent PJI in another arthroplasty with 12% recurring in the initial arthroplasty and nearly 10% ocurring in another arthroplasty. Particular caution should be taken in patients who use tobacco, have bacteremia, or have Staphylococcus aureus isolation at time of their initial PJI. Optimizing the management of this high-risk patient population is necessary to reduce the additional burden of subsequent PJI.
LEVEL OF EVIDENCE
Prognostic Level IV.
背景
初次关节置换术后的假体周围关节感染（PJI）发生率超过 1%。超过 30%的初次关节置换术患者需要再次进行关节置换，而 PJI 对这部分患者的影响尚未得到充分研究。我们的目的是评估在多次关节置换术且至少发生一次 PJI 的患者中，复发性、同期和异时性 PJI 的发生率，并确定发生后续 PJI 的风险因素。
方法
我们确定了 2003 年至 2021 年间进行多次关节置换术且至少发生一次 PJI 的 337 例患者。翻修关节置换术后的平均随访时间为 3 年（0 至 17.2 年）。将存在多例感染假体的患者分为同期（即与初次感染同时发生）或异时性（即与初次感染不同时发生）。PJI 诊断采用 MusculoSkeletal Infection Society（MSIS）标准。
结果
39 例（12%）患者在同一关节发生复发性 PJI，31 例（9%）患者在另一关节发生 PJI。与复发性 PJI（23%）或单发 PJI（15%）相比，第二关节 PJI 中血培养阳性更常见（48%比 23%和 15%，P<0.001）。同期 PJI 占第二关节 PJI 病例的 42%（n=13），而异时性 PJI 占 58%（n=18）。吸烟者发生异时性 PJI 的风险增加 75%（比值比 1.75，95%置信区间：1.1-2.9，P=0.041）。
结论
在初次关节置换术后发生一次 PJI 的多次关节置换术患者中，超过 20%将在另一关节发生后续 PJI，其中 12%在初次关节置换术中复发，近 10%在另一关节置换术中发生。在初次 PJI 时发生菌血症或分离出金黄色葡萄球菌的患者以及吸烟的患者，应特别谨慎。优化这类高危患者人群的管理对于减少后续 PJI 的发生至关重要。
证据等级
预后 IV 级。
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