Carender Christopher N, Fruth Kristin M, Lewallen David G, Berry Daniel J, Abdel Matthew P, Bedard Nicholas A
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 May;40(5):1204-1209.e4. doi: 10.1016/j.arth.2024.10.064. Epub 2024 Oct 22.
When indicating patients for primary total knee arthroplasty (TKA), surgeons and patients must understand the absolute and relative risks of periprosthetic joint infection (PJI) to make an informed decision. We sought to evaluate the long-term risk of PJI following primary TKA stratified by body mass index (BMI) and PJI-related risk factors.
We identified 25,160 primary TKAs performed from 2000 to 2021 at a single institution. Patients were stratified as having 0, 1, or ≥ 2 PJI risk factors (diabetes, chronic kidney disease, nonprimary osteoarthritis, immunosuppression, or active smoking) and into BMI categories. The 15-year cumulative risk of PJI was evaluated by BMI and PJI risk factors.
For the entire cohort, the 15-year absolute risk of PJI was 3%. For patients who did not have PJI risk factors, the absolute risk of PJI at 15 years was 3% in normal weight, 4% in class III obesity, and 4% in class IV obesity. Patients who had class III obesity had a 3-time higher relative risk of PJI when than normal-weight patients (P = 0.01). Among patients who had ≥ 2 PJI risk factors, the absolute risk of PJI at 15 years was 5% in normal weight and 6% in patients who have class III obesity.
Healthy patients who had class III obesity had a 3-time increased risk of PJI relative to healthy, normal-weight patients; however, the absolute risk of PJI at 15 years after primary TKA was 4% in this group. Surgeons and patients must consider both a 3-time increased relative risk of PJI and a 4% absolute risk of PJI at 15 years after primary TKA when considering surgery in otherwise healthy patients who have BMI ≥ 40.
IV.
在为患者进行初次全膝关节置换术（TKA）时，外科医生和患者必须了解假体周围关节感染（PJI）的绝对风险和相对风险，以便做出明智的决定。我们试图评估初次TKA后按体重指数（BMI）和PJI相关风险因素分层的PJI长期风险。
我们确定了2000年至2021年在单一机构进行的25160例初次TKA。患者被分为具有0、1或≥2个PJI风险因素（糖尿病、慢性肾病、非原发性骨关节炎、免疫抑制或主动吸烟）以及不同的BMI类别。通过BMI和PJI风险因素评估PJI的15年累积风险。
对于整个队列，PJI的15年绝对风险为3%。对于没有PJI风险因素的患者，正常体重者15年PJI的绝对风险为3%，III级肥胖者为4%，IV级肥胖者为4%。III级肥胖患者发生PJI的相对风险是正常体重患者的3倍（P = 0.01）。在具有≥2个PJI风险因素的患者中，正常体重者15年PJI的绝对风险为5%，III级肥胖患者为6%。
健康的III级肥胖患者发生PJI的风险相对于健康的正常体重患者增加了3倍；然而，该组初次TKA后15年PJI的绝对风险为4%。在考虑为BMI≥40的其他健康患者进行手术时，外科医生和患者必须同时考虑初次TKA后15年PJI相对风险增加3倍和绝对风险4%的情况。
IV级。
