低种植体容积、合并症、男性性别和限制性 TKA 植入被确定为膝关节置换术后感染性翻修的危险因素：来自德国关节置换登记处的基于登记的研究。
Low implantation volume, comorbidities, male sex and implantation of constrained TKA identified as risk factors for septic revision in knee arthroplasty: A register-based study from the German Arthroplasty Registry.
机构信息
Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Deutsches Endoprothesenregister gGmbH (EPRD), Berlin, Germany.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2024 Jul;32(7):1743-1752. doi: 10.1002/ksa.12182. Epub 2024 Apr 17.
PURPOSE
Periprosthetic joint infection (PJI) is a major cause of revision surgery after total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA). Patient- and hospital-related risk factors need to be assessed to prevent PJI. This study identifies influential factors and differences in infection rates between different implant types.
METHODS
Data were obtained from the German Arthroplasty Registry. Septic revisions were calculated using Kaplan-Meier estimates with septic revision surgery as the primary endpoint. Patients with constrained and unconstrained TKA or UKA were analysed using Holm's multiple log-rank test and Cox's proportional hazards ratio. The 300,998 cases of knee arthroplasty analysed included 254,144 (84.4%) unconstrained TKA, 9993 (3.3%) constrained TKA and 36,861 (12.3%) UKA with a maximum follow-up of 7 years.
RESULTS
At 1 year, the PJI rate was 0.5% for UKA and 2.8% for TKA, whereas at 7 years, the PJI rate was 4.5% for UKA and 0.9% for TKA (p < 0.0001). The PJI rate significantly increased for constrained TKA compared to unconstrained TKA (p < 0.0001). The PJI rate was 2.0% for constrained TKA and 0.8% for unconstrained TKA at 1 year and 3.1% and 1.4% at 7 years. Implantation of a constrained TKA (hazard ratio [HR] = 2.55), male sex (HR = 1.84), increased Elixhauser score (HR = 1.18-1.56) and implant volume of less than 25 UKA per year (HR = 2.15) were identified as risk factors for revision surgery; an Elixhauser score of 0 (HR = 0.80) was found to be a preventive factor.
CONCLUSIONS
Reduced implant volume and constrained knee arthroplasty are associated with a higher risk of PJI. Comorbidities (elevated Elixhauser score), male sex and low UKA implant volume have been identified as risk factors for PJI. Patients who meet these criteria require specific measures to prevent infection. Further research is required on the potential impact of prevention and risk factor modification.
LEVEL OF EVIDENCE
Level III.
目的
假体周围关节感染（PJI）是全膝关节置换术（TKA）和单髁膝关节置换术（UKA）后翻修手术的主要原因。需要评估患者和医院相关的危险因素，以预防 PJI。本研究确定了不同植入物类型之间感染率的影响因素和差异。
方法
数据来自德国关节置换登记处。使用 Kaplan-Meier 估计计算感染性翻修，以感染性翻修手术为主要终点。使用 Holm 多重对数秩检验和 Cox 比例风险比分析了约束和非约束 TKA 或 UKA 的患者。分析了 300998 例膝关节置换病例，包括 254144 例（84.4%）非约束性 TKA、9993 例（3.3%）约束性 TKA 和 36861 例（12.3%）UKA，随访时间最长为 7 年。
结果
在 1 年时，UKA 的 PJI 发生率为 0.5%，TKA 为 2.8%，而在 7 年时，UKA 的 PJI 发生率为 4.5%，TKA 为 0.9%（p<0.0001）。与非约束性 TKA 相比，约束性 TKA 的 PJI 发生率显著增加（p<0.0001）。1 年时，约束性 TKA 的 PJI 发生率为 2.0%，非约束性 TKA 为 0.8%，7 年时分别为 3.1%和 1.4%。植入约束性 TKA（风险比[HR]＝2.55）、男性（HR＝1.84）、Elixhauser 评分升高（HR＝1.18-1.56）和每年植入 UKA 少于 25 个（HR＝2.15）被确定为翻修手术的危险因素；Elixhauser 评分为 0（HR＝0.80）被认为是预防因素。
结论
减少植入物体积和约束性膝关节置换术与 PJI 的风险增加相关。合并症（Elixhauser 评分升高）、男性和 UKA 植入物体积低已被确定为 PJI 的危险因素。符合这些标准的患者需要采取具体措施预防感染。需要进一步研究预防和危险因素改变的潜在影响。
证据水平
III 级。
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