The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway.
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
Acta Orthop. 2023 Jun 27;94:307-315. doi: 10.2340/17453674.2023.13648.
The incidence of periprosthetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004-2018.
569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan-Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addition, we explored changes in the time span from primary THA to revision due to infection.
5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5-8.9) years after surgery. Compared with the period 2004-2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3-1.5) for 2009-2013, and 1.9 (CI 1.7-2.0) for 2014-2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7-0.7), 1.0% (CI 0.9-1.0), and 1.2% (CI 1.2-1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revision due to infection. Compared with 2004-2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1-2.9) for 2009-2013, and 3.4 (CI 3.0-3.9) for 2013-2018. The aHR for revision within 31-90 days after THA was 1.5 (CI 1.3-1.9) for 2009-2013, and 2.5 (CI 2.1-3.0) for 2013-2018, compared with 2004-2008.
The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004-2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a "true" increase (i.e., frailer patients or more use of uncemented implants) and/or an "apparent" increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.
全髋关节置换术后（THA）发生假体周围关节感染的发病率可能在增加。我们对北欧国家 2004-2018 年期间初次 THA 后感染性翻修的风险、发生率和时间趋势进行了分析。
对 2004 年至 2018 年期间北欧关节置换登记协会报告的 569463 例初次 THA 进行了研究。通过 Kaplan-Meier 和累积发生率函数方法计算绝对风险估计值，通过 Cox 回归评估调整后的危险比（aHR），以初次 THA 后因感染而进行的首次翻修为主要终点。此外，我们还探讨了初次 THA 至感染性翻修的时间间隔的变化。
在中位随访时间 5.4（IQR 2.5-8.9）年后，5653 例（1.0%）初次 THA 因感染而翻修。与 2004-2008 年相比，2009-2013 年和 2014-2018 年的 aHR 分别为 1.4（95%置信区间 [CI] 1.3-1.5）和 1.9（CI 1.7-2.0）。3 个时间段的 5 年感染性翻修绝对发生率分别为 0.7%（CI 0.7-0.7）、1.0%（CI 0.9-1.0）和 1.2%（CI 1.2-1.3）。我们发现初次 THA 至感染性翻修的时间间隔发生了变化。与 2004-2008 年相比，2009-2013 年 30 天内翻修的 aHR 为 2.5（CI 2.1-2.9），2013-2018 年为 3.4（CI 3.0-3.9）。2009-2013 年 31-90 天内翻修的 aHR 为 1.5（CI 1.3-1.9），2013-2018 年为 2.5（CI 2.1-3.0），均高于 2004-2008 年。
2004-2018 年期间，初次 THA 后感染性翻修的风险无论是在绝对累积发生率还是相对风险方面均几乎翻了一番。这种增加主要是由于 THA 后 90 天内翻修的风险增加所致。这可能反映了假体周围关节感染发病率的“真实”（即更脆弱的患者或更多使用非骨水泥植入物）和/或“表观”（即诊断改进、翻修策略改变或报告的完整性）增加。目前的研究无法揭示这些变化，这需要进一步的研究。
