Loppini Mattia, Bella Ludovico La, Rocchi Caterina, Morenghi Emanuela, Chiappetta Katia, Rusconi Roberto, Grappiolo Guido
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, 20090, Italy.
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, 20089, Italy.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):38. doi: 10.1007/s00402-024-05706-7.
Periprosthetic joint infections (PJIs) occur at a rate of 1-2% in primary arthroplasties and 4% in revisions, posing a significant healthcare challenge. PJI diagnosis is hindered by absence of a universally accepted diagnostic standard. The primary outcome was to develop a predictive model to identify patients at risk of developing unforeseen PJI subsequent to presumed aseptic revision of total hip arthroplasty (THA). The secondary aim was to determine the reintervention-free survival rate among aseptic patients and those presenting unexpected positive cultures.
This study included all ascertained septic and presumed aseptic patients without mechanical causes of THA failure and with sufficient clinical and laboratory data. Patients with incomplete anamnestic data, mechanical loosening related causes, rheumatologic conditions, or immunosuppression were excluded. Univariable and multivariable logistic regression analyses identified preoperative predictive markers for unexpected hip PJI.
283 inpatients from a high volume referral center were recruited from 2016 to 2019. The predictive preoperative parameters related with hip PJI were: presence of comorbidities (OR: 0.28; 95% CI 0.10-0.78), erythrocyte sedimentation rate (OR: 1.02; 95% CI 1.00-1.03), leukocyte count (OR: 1.18; 95% CI 1.02-1.36) and prothrombin time (OR: 1.42; 95% CI 1.02-1.98). Gender, age, body mass index (BMI) and previous surgery were not significantly related with unexpected PJI. Overall, the Kaplan-Meier analysis estimated a reoperation-free survival rate at 36 months of 96% (CI 95%) for the aseptic and 98% (CI 95%) for the unexpected group; however, the relation between the two survival curves was not significant (p = 0.086).
Erythrocyte sedimentation rate, leukocyte count, and increased prothrombin time were risk factors for PJI, whereas comorbidities were associated with a lower risk. Further research is needed to understand this association fully. Larger datasets are recommended to explore the complex interplay between risk factors and PJI development.
人工关节周围感染（PJI）在初次关节置换术中的发生率为1%-2%，在翻修手术中的发生率为4%，这对医疗保健构成了重大挑战。由于缺乏普遍接受的诊断标准，PJI的诊断受到阻碍。主要结果是开发一种预测模型，以识别在全髋关节置换术（THA）假定无菌翻修后有发生意外PJI风险的患者。次要目的是确定无菌患者和培养结果意外呈阳性的患者的无再次干预生存率。
本研究纳入了所有已确诊的感染性和假定无菌性患者，这些患者没有THA失败的机械性原因，且有足够的临床和实验室数据。排除病史数据不完整、机械性松动相关原因、风湿性疾病或免疫抑制的患者。单变量和多变量逻辑回归分析确定了意外髋关节PJI的术前预测指标。
2016年至2019年从一家大型转诊中心招募了283名住院患者。与髋关节PJI相关的术前预测参数为：合并症的存在（比值比：0.28；95%置信区间0.10-0.78）、红细胞沉降率（比值比：1.02；95%置信区间1.00-1.03）、白细胞计数（比值比：1.18；95%置信区间1.02-1.36）和凝血酶原时间（比值比：1.42；95%置信区间1.02-1.98）。性别、年龄、体重指数（BMI）和既往手术与意外PJI无显著相关性。总体而言，Kaplan-Meier分析估计，无菌组36个月时的无再次手术生存率为96%（95%置信区间），意外组为98%（95%置信区间）；然而，两条生存曲线之间的关系不显著（p = 0.086）。
红细胞沉降率、白细胞计数和凝血酶原时间延长是PJI的危险因素，而合并症与较低风险相关。需要进一步研究以充分理解这种关联。建议使用更大的数据集来探索危险因素与PJI发生之间的复杂相互作用。
