Wetzel Robert M, Ayala Giovanni A, Grayson Christopher W, Miranda Michael A, Simon Peter, Lyons Steven T
Florida Orthopaedic Institute, Adult Reconstruction Service, Temple Terrace, FL, USA.
Foundation for Orthopaedic Research and Education, Research Department, Tampa, FL, USA.
Arthroplast Today. 2024 Feb 20;26:101323. doi: 10.1016/j.artd.2024.101323. eCollection 2024 Apr.
The risk of periprosthetic joint infection (PJI) subsequently developing at a second site after an initial PJI has been documented to be approximately 18%-20%. To the best of our knowledge, only a single study has evaluated the incidence in ipsilateral joints and if the risk of infection would be different. While this was the only other study to evaluate this specific subfield, we set to re-evaluate and confirm the incidence of developing a second PJI in the setting of an ipsilateral prosthesis and possible associated risk factors.
We retrospectively reviewed all patients treated surgically for lower-extremity PJI at our institution by 5 surgeons from 2015 to 2021. Patients with multiple arthroplasties on the ipsilateral extremity were included. Time between initial and subsequent infection, risk factors for infection, bacterial source, and bacteremia were identified.
Of 392 patients treated for PJI, 179 (45.6%) had multiple prosthetic joints. Forty-seven of those 179 patients had ipsilateral extremity prosthesis, which made up our study population. Three patients (6.4%) developed a separate infection at an ipsilateral TJA. In total, 10 patients (21.3%) developed a separate PJI. Patients on immunosuppressants had a higher likelihood of developing second PJI on the ipsilateral extremity ( = .02).
Our study identified the risk of developing an ipsilateral PJI to not be any greater than that in patients with contralateral TJAs. It appears that sharing an extremity with an infected TJA does not pose substantially increased risk of subsequent infection of the un-involved prosthesis. Furthermore, immunosuppressant use may increase the risk of a separate ipsilateral PJI.
在初次人工关节周围感染（PJI）被记录后，第二个部位随后发生PJI的风险约为18%-20%。据我们所知，仅有一项研究评估了同侧关节的发病率以及感染风险是否会有所不同。虽然这是唯一一项评估该特定子领域的研究，但我们着手重新评估并确认在同侧假体情况下发生第二次PJI的发病率以及可能的相关风险因素。
我们回顾性分析了2015年至2021年期间由5位外科医生在我们机构接受手术治疗的所有下肢PJI患者。纳入同侧肢体进行多次关节置换的患者。确定初次感染与后续感染之间的时间、感染风险因素、细菌来源和菌血症。
在392例接受PJI治疗的患者中，179例（45.6%）有多个假体关节。这179例患者中有47例同侧肢体有假体，构成了我们的研究人群。3例患者（6.4%）在同侧全膝关节置换（TJA）处发生了单独感染。总共有10例患者（21.3%）发生了单独的PJI。使用免疫抑制剂的患者在同侧肢体发生第二次PJI的可能性更高（P = 0.02）。
我们的研究发现，同侧发生PJI的风险并不高于对侧TJA患者。似乎与感染的TJA共用一个肢体并不会显著增加未受累假体后续感染的风险。此外，使用免疫抑制剂可能会增加同侧单独发生PJI的风险。
