不明原因及疑似无菌性髋关节和膝关节翻修术中意外阳性术中培养物的患病率、危险因素、微生物学结果及临床结局——一项至少随访2年的十年回顾性分析
Prevalence, risk factors, microbiological results and clinical outcome in unexpected positive intraoperative cultures in unclear and presumed aseptic hip and knee revision arthroplasties - A ten-year retrospective analysis with a minimum follow up of 2 years.
作者信息
Simon Sebastian, Martalanz Luca, Frank Bernhard J H, Hartmann Susana Gardete, Mitterer Jennyfer A, Sebastian Sujeesh, Huber Stephanie, Hofstaetter Jochen G
机构信息
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, 1130, Vienna, Austria.
II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, 1130, Vienna, Austria.
出版信息
J Orthop Translat. 2024 Aug 17;48:156-162. doi: 10.1016/j.jot.2024.08.002. eCollection 2024 Sep.
BACKGROUND
The aim of this study was to assess the prevalence, microbiological spectrum, risk factors, and clinical outcomes of unexpected-positive-intraoperative-cultures (UPIC) in presumed aseptic and unclear revision-total-hip-/knee-arthroplasties (rTHA and rTKA) compared to culture-negative (CN) revisions.
METHODS
This study reviewed all International-consensus-meeting-2018 (ICM 2018) negative or inconclusive rTHA (n = 751) and rTKA (n = 679) performed at our institution from 2011 to 2020 with a minimum follow-up of two years. A Kaplan-Meier-analysis was performed to determine the septic and aseptic-free implant survival in cases with UPIC's and matched culture-negative cases. Patient demographics, risk factors, microbiological spectrum and clinical outcomes were evaluated.
RESULTS
There were significantly more UPIC cases in rTHA 196/751 (26.1 %) compared to rTKA 113/679 (16.6 %); (p < 0.001). UPICs in rTKA and rTHA have a lower septic and aseptic implant-free-survival compared to CN revisions. Patients with a history of nickel allergy have a higher risk of an UPIC in rTHA and rTKA (p < 0.001). Septic re-revisions after UPIC had a significantly (H: p = 0.004; K: p = 0.030) shorter time period to the primary/previous surgery (H: 84 (IQR:41-797); K: 115 (IQR:55-446)) compared to patients with aseptic re-revisions after UPIC (H:1248 (IQR:178-3534); K: 827 (IQR:361-1183)).
CONCLUSION
UPICs have a higher rate of septic and aseptic failure than CN outcomes. UPICs are twice as common in rTHA compared to rTKA. Preoperative PJI workup reduces the UPIC rate. Nickel allergy is a risk factor for UPIC. Early revisions with UPICs after primary THA or TKA have a higher risk of septic failure.
THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE
This article provides new information on revision rates for UPIC and potential risk factors for UPIC and its treatment failure.
背景
本研究的目的是评估在假定为无菌的不明确的全髋关节/膝关节翻修术（rTHA和rTKA）中意外术中培养阳性（UPIC）的发生率、微生物谱、危险因素和临床结果，并与培养阴性（CN）的翻修术进行比较。
方法
本研究回顾了2011年至2020年在我们机构进行的所有2018年国际共识会议（ICM 2018）阴性或不确定的rTHA（n = 751）和rTKA（n = 679），最小随访时间为两年。进行Kaplan-Meier分析以确定UPIC病例和匹配的培养阴性病例的感染性和无菌性植入物生存率。评估患者的人口统计学、危险因素、微生物谱和临床结果。
结果
与rTKA的113/679（16.6%）相比，rTHA的UPIC病例显著更多，为196/751（26.1%）；（p < 0.001）。与CN翻修术相比，rTKA和rTHA中的UPIC具有更低的感染性和无菌性植入物无生存率。有镍过敏史的患者在rTHA和rTKA中发生UPIC的风险更高（p < 0.001）。与UPIC后无菌性再次翻修的患者相比，UPIC后感染性再次翻修与初次/上次手术的时间间隔显著更短（H：p = 0.004；K：p = 0.030）（H：84（IQR：41 - 797）；K：115（IQR：55 - 446））（H：1248（IQR：178 - 3534）；K：827（IQR：361 - 1183））。
结论
与CN结果相比，UPIC的感染性和无菌性失败率更高。与rTKA相比，rTHA中UPIC的发生率是其两倍。术前PJI检查可降低UPIC发生率。镍过敏是UPIC的一个危险因素。初次THA或TKA后早期进行UPIC翻修的感染性失败风险更高。
本文的转化潜力
本文提供了关于UPIC翻修率以及UPIC及其治疗失败的潜在危险因素的新信息。
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