Sydney Knee Specialists, Kogarah, New South Wales, Australia.
Centre for Big Data Research in Health, University of New South Wales, Kensington, New South Wales, Australia; Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia.
J Arthroplasty. 2024 Jan;39(1):151-156. doi: 10.1016/j.arth.2023.06.033. Epub 2023 Jun 26.
Prosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). This study aimed to determine if the anterior approach (AP) influenced the incidence of early PJI in THA compared to posterior approach (PP).
Record linkage was performed between state-wide hospitalization data and a national joint replacement registry to identify unilateral THA performed via the AP or PP. Complete data on 12,605 AP and 25,569 PP THAs were obtained. Propensity score matching (PSM) was undertaken to match covariates between the approaches. Outcomes were the 90-day PJI hospital readmission rate(using narrow and broad definitions) and 90-day PJI revision rate (defined as component removal or exchange).
The raw PJI readmission rate for AP was lower than PP (0.8% versus 1.1%, respectively). In the PSM analysis, there was no statistically significant difference in PJI readmission rate between approaches using narrow or broad definition of PJI readmission. In terms of revision for infection, both methods showed AP had a significantly lower rate than PP, with an adjusted odds ratio (OR) of 0.47 (95% confidence interval (CI) 0.30, 0.75) for the 1:1 nearest neighbor method and 0.50 (95% CI 0.32, 0.77) for the subclassification method.
After addressing known confounders, there was no significant difference in the 90-day hospital readmission rate for hip PJI between approaches. There was a significantly reduced 90-day PJI revision rate for AP. The difference in revision may reflect differences in the surgical management of PJI between hip approaches rather than a difference in the underlying rate of infection.
人工关节感染（PJI）是全髋关节置换术（THA）的一种破坏性并发症。本研究旨在确定与后入路（PP）相比，前路（AP）是否会影响 THA 早期 PJI 的发生率。
通过全州住院数据和国家关节置换登记处进行记录链接，以确定通过 AP 或 PP 进行的单侧 THA。获得了 12605 例 AP 和 25569 例 PP THA 的完整数据。采用倾向评分匹配（PSM）对两种方法的协变量进行匹配。结果是 90 天 PJI 住院再入院率（使用狭义和广义定义）和 90 天 PJI 翻修率（定义为组件去除或更换）。
AP 的 PJI 再入院率低于 PP（分别为 0.8%和 1.1%）。在 PSM 分析中，使用狭义或广义 PJI 再入院定义，两种方法之间的 PJI 再入院率没有统计学差异。就感染翻修而言，两种方法均显示 AP 的发生率明显低于 PP，调整后的比值比（OR）分别为 0.47（95%可信区间（CI）为 0.30，0.75）和 0.50（95%CI 为 0.32，0.77）。
在考虑了已知混杂因素后，两种方法的 90 天髋关节 PJI 住院再入院率没有显著差异。AP 的 90 天 PJI 翻修率显著降低。翻修率的差异可能反映了髋关节入路之间 PJI 手术管理的差异，而不是感染率的差异。
