Department of Orthopaedic Surgery, Helios ENDO-Klinik, Holstenstr. 2, 22767, Hamburg, Germany.
Joint Reconstruction Unit, Southland Hospital, Invercargill, New Zealand.
Arch Orthop Trauma Surg. 2024 Jan;144(1):341-346. doi: 10.1007/s00402-023-05059-7. Epub 2023 Sep 24.
Hepatitis B and C are important and relatively common health issues. It is known that many patients who underwent total knee and hip arthroplasty were also diagnosed with hepatitis. These patients are at higher risk of periprosthetic joint infection (PJI). This study aimed to investigate the differences in PJI cases in hepatitis B and C patients.
This is a retrospective case-controlled single-center study. A total of 270 patients with hepatitis and non-hepatitis (control group) who underwent one-stage septic exchange to the hip and knee joints were included in the study. All patients' previous surgical histories, infective organisms, C-reactive protein (CRP) values before septic exchange, and demographic data were evaluated. All microbiological and laboratory evaluations were performed separately for knee and hip arthroplasty.
The mean CRP levels of Hep B- and C-positive patients, who underwent one-stage septic exchange in the knee joint, were 23.6 mg/L. In the control group, this value was 43.1 mg/L and a statistically significant difference was found between the groups (p = 0.004). Gram-negative organisms were identified in a larger proportion of patients with hepatitis who developed PJI in both hip and knee joints and underwent one-stage septic exchange (p = 0.041/p = 0.044).
PJIs caused by Gram-negative bacteria are encountered more frequently in patients with hepatitis than in the control group. In addition, the CRP rise is less in patients with hepatitis compared to PJI cases in the control group. Patient-specific evaluation is required in cases of PJI in patient groups with co-existing hepatitis.
乙型肝炎和丙型肝炎是重要且相对常见的健康问题。已知许多接受全膝关节和髋关节置换术的患者也被诊断患有肝炎。这些患者发生假体周围关节感染（PJI）的风险较高。本研究旨在探讨乙型肝炎和丙型肝炎患者的 PJI 病例差异。
这是一项回顾性病例对照单中心研究。共纳入 270 例接受一期关节感染性髋关节和膝关节置换术的乙型肝炎和非乙型肝炎（对照组）患者。评估了所有患者的既往手术史、感染病原体、关节感染性置换术前 C 反应蛋白（CRP）值以及人口统计学数据。分别对膝关节和髋关节置换术进行所有微生物学和实验室评估。
在接受一期关节感染性膝关节置换术的乙型肝炎和丙型肝炎阳性患者中，平均 CRP 水平为 23.6mg/L。在对照组中，该值为 43.1mg/L，两组之间存在统计学显著差异（p=0.004）。在接受一期关节感染性髋关节和膝关节置换术的乙型肝炎患者中，发生 PJI 的患者中更多比例的病原体为革兰氏阴性菌（p=0.041/p=0.044）。
与对照组相比，乙型肝炎患者发生革兰氏阴性菌引起的 PJI 更为常见。此外，与对照组的 PJI 病例相比，乙型肝炎患者的 CRP 升高幅度较小。在伴有乙型肝炎的患者群体中，出现 PJI 时需要进行个体化评估。
