Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2024 Sep;39(9S2):S425-S428. doi: 10.1016/j.arth.2024.03.034. Epub 2024 Mar 20.
Periprosthetic joint infections (PJIs) of total hip arthroplasty (THA) or total knee arthroplasty (TKA) may occur in the setting of an uninfected ipsilateral prosthetic joint. However, the risk to that uninfected ipsilateral joint is unknown. We analyzed the survivorship free from PJI in at risk THAs and TKAs following treatment of an ipsilateral knee or hip PJI, respectively.
Using our institutional total joint registry, we identified 205 patients who underwent treatment for PJI (123 THAs and 83 TKAs) with an at-risk ipsilateral in situ knee or hip, respectively, between 2000 and 2019. In total, 54% of index PJIs were chronic and 46% were acute. The mean age was 70 years, 47% were female, and the mean body mass index was 32. Kaplan-Meier survivorship analyses were performed. Mean follow-up was 6 years.
The 5-year survivorship free of PJI in an at-risk THA after an ipsilateral TKA was treated for PJI was 97%. The 5-year survivorship free of PJI in an at-risk TKA when the ipsilateral THA was treated for PJI was 99%. Three PJIs occurred (2 THAs and 1 TKA), all over 1 year from the index ipsilateral PJI treatment. One hip PJI was an acute hematogenous infection that resulted from pneumonia. The other 2 new PJIs were caused by the same organism as the index PJI and were due to a failure of source control at the index joint.
When diagnosed with PJI in a single joint, the risk of developing PJI in an ipsilateral prosthetic joint within 5 years was low (1 to 3% risk). In the rare event of an ipsilateral infection, all occurred greater than one year from the index PJI and 2 of 3 were with the same organism when source infection control failed.
Prognostic Level III.
全髋关节置换术（THA）或全膝关节置换术（TKA）的假体周围关节感染（PJI）可能发生在未感染的同侧假体关节中。然而，该未感染的同侧关节的风险尚不清楚。我们分别分析了同侧膝关节或髋关节 PJI 治疗后，风险较高的 THA 和 TKA 无 PJI 生存情况。
使用我们的机构全关节登记处，我们确定了 205 名患者，他们在 2000 年至 2019 年期间分别接受了同侧膝关节或髋关节 PJI（123 例 THA 和 83 例 TKA）的治疗，且同侧存在有风险的原位膝关节或髋关节。54%的指数 PJI 为慢性，46%为急性。平均年龄为 70 岁，47%为女性，平均体重指数为 32。进行 Kaplan-Meier 生存分析。平均随访 6 年。
同侧 TKA 治疗 PJI 后，高风险 THA 无 PJI 5 年生存率为 97%。同侧 THA 治疗 PJI 后，高风险 TKA 无 PJI 5 年生存率为 99%。发生了 3 例 PJI（2 例 THA 和 1 例 TKA），均在指数同侧 PJI 治疗后 1 年以上。1 例髋关节 PJI 为急性血源性感染，由肺炎引起。另外 2 例新的 PJI 由与指数 PJI 相同的病原体引起，是由于指数关节的源头感染控制失败。
当诊断为单个关节的 PJI 时，5 年内同侧假体关节发生 PJI 的风险较低（1%至 3%的风险）。在同侧感染的罕见情况下，所有感染均发生在指数 PJI 后 1 年以上，且 3 例中有 2 例在源感染控制失败时具有相同的病原体。
预后 III 级。
