Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
J Arthroplasty. 2023 Nov;38(11):2447-2454. doi: 10.1016/j.arth.2023.05.033. Epub 2023 May 24.
Prosthetic joint infection (PJI) is one of the most devastating complications after total knee arthroplasty (TKA), and comorbidities increase the risk. We examined whether a temporal change has occurred in the demographics, especially regarding comorbidities, of patients who have PJI and were treated at our institution over a 13-year study period. In addition, we assessed the surgical methods used and the microbiology of the PJIs.
Revisions (n = 384, 377 patients) due to PJI of the knee performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and retention (DAIR), 1-stage revision, and 2-stage revision. Infections were classified as early, acute hematogenous, and chronic.
No changes in the median age of the patients nor comorbidity burden were observed during the study period. However, the proportion of 2-stage revisions decreased remarkably from 57.6% in 2008 to 2009 to 6.3% in 2020 to 2021. A DAIR was the most used treatment strategy, but the proportion of 1-stage revisions increased the most. In 2008 to 2009, 12.1% of the revisions were 1-stage, but in 2020 to 2021, the proportion was 43.8%. The most common pathogen was Staphylococcus aureus (27.8%).
The comorbidity burden remained at the same level with no trends. A DAIR was the most used strategy, but the proportion of 1-stage revisions rose to almost the same level. The incidence of PJI varied between the years, but remained relatively low.
人工关节感染（PJI）是全膝关节置换术（TKA）后最具破坏性的并发症之一，合并症会增加其风险。我们研究了在我们机构的 13 年研究期间，患有 PJI 并接受治疗的患者在人口统计学方面，特别是合并症方面是否发生了时间变化。此外，我们评估了手术方法和 PJI 的微生物学。
确定了我们机构 2008 年至 2021 年 9 月期间因膝关节 PJI 进行的翻修手术（n=384，377 名患者）。所有纳入的 PJI 均符合 2013 年国际共识会议诊断标准。手术分为以下几类：清创术、抗生素和保留（DAIR）、1 期翻修术和 2 期翻修术。感染分为早期、急性血源性和慢性。
研究期间，患者的中位年龄和合并症负担均无变化。然而，2 期翻修的比例从 2008 年至 2009 年的 57.6%显著下降到 2020 年至 2021 年的 6.3%。DAIR 是最常用的治疗策略，但 1 期翻修的比例增长最多。2008 年至 2009 年，12.1%的翻修术为 1 期，而 2020 年至 2021 年，这一比例为 43.8%。最常见的病原体是金黄色葡萄球菌（27.8%）。
合并症负担保持在同一水平，没有趋势。DAIR 是最常用的策略，但 1 期翻修的比例上升到几乎相同的水平。PJI 的发病率在不同年份有所不同，但仍相对较低。
