International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2nd Floor, Baltimore, 2401, MD, USA.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Arch Orthop Trauma Surg. 2024 Dec;144(12):5147-5155. doi: 10.1007/s00402-024-05307-4. Epub 2024 May 2.
Total Joint Arthroplasties (TJAs) are becoming more popular, resulting in a growing economic burden due to potential postoperative complications, with periprosthetic joint infections (PJIs) playing a significant role. The effect of immunosuppression on PJI risk, particularly in cancer patients following chemotherapy, is unknown. The hypothesis of this study investigated whether chemotherapy increases PJI rates in patients who received post-arthroplasty chemotherapy within one year of surgery.
Data from the M161Ortho dataset of PearlDiver patient records database were utilized using ICD-9, ICD-10, and CPT codes. The cohort includes Total Knee Arthroplasty (TKA), Total Hip Arthroplasty (THA), and Total Shoulder Arthroplasty (TSA) patients who underwent post-arthroplasty chemotherapy within one year after surgery between 2010 and 2022. Patients in the matched control group did not receive post-arthroplasty chemotherapy. Pre-arthroplasty chemotherapy recipients, PJI, and post-op first year revisions were excluded. Analyses including the linear logistic regression were performed via R statistical software.
Totally, 17,026 patients (8,558 TKAs, 6,707 THAs, and 1,761 TSAs) were included. At two (OR = 1.59, p = 0.034), three (OR = 1.57, p = 0.009), and four (OR = 1.40, p = 0.032) years for TKA, and two (OR = 2.27, p = 0.008), three (OR = 2.32, p < 0.001), and four (OR = 2.25, p0.001) years for THA, PJI rates were significantly higher in the chemotherapy group. TSA patients had a significant rise in PJI after four years (OR = 2.20, p = 0.031).
This study reveals a possible relationship between postoperative chemotherapy and an increased incidence of PJI in patients with arthroplasty. Chemotherapy suppresses the immune system, rendering patients more vulnerable to infections. Additional research is required to confirm these findings.
全关节置换术（TJA）越来越受欢迎，由于潜在的术后并发症，导致经济负担不断增加，其中假体周围关节感染（PJI）起着重要作用。化疗对 PJI 风险的影响，特别是在接受化疗的癌症患者中，尚不清楚。本研究的假设是调查在手术后一年内接受关节置换术后化疗的患者中，化疗是否会增加 PJI 发生率。
使用 PearlDiver 患者记录数据库的 M161Ortho 数据集，使用 ICD-9、ICD-10 和 CPT 代码。该队列包括 2010 年至 2022 年间在手术后一年内接受关节置换术后化疗的全膝关节置换术（TKA）、全髋关节置换术（THA）和全肩关节置换术（TSA）患者。未接受关节置换术后化疗的患者被纳入匹配对照组。排除了术前化疗接受者、PJI 和术后第一年翻修。通过 R 统计软件进行包括线性逻辑回归在内的分析。
总共纳入了 17026 名患者（8558 例 TKA、6707 例 THA 和 1761 例 TSA）。在 TKA 的两年（OR=1.59，p=0.034）、三年（OR=1.57，p=0.009）和四年（OR=1.40，p=0.032），THA 的两年（OR=2.27，p=0.008）、三年（OR=2.32，p<0.001）和四年（OR=2.25，p<0.001），化疗组的 PJI 发生率显著更高。TSA 患者在四年后 PJI 发生率显著升高（OR=2.20，p=0.031）。
本研究揭示了关节置换术后化疗与 PJI 发生率增加之间可能存在的关系。化疗会抑制免疫系统，使患者更容易感染。需要进一步的研究来证实这些发现。
