Li Yi, Quan Xiaolin, Zhou Cheng, Duan Xin, Nie Mao, Si Haibo
Department of Orthopaedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, 610041, China.
Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.
J Orthop Surg Res. 2025 Mar 18;20(1):293. doi: 10.1186/s13018-025-05694-3.
Although periprosthetic joint infection (PJI) can affect multiple joints simultaneously, most individuals with multiple joint involvement exhibit PJI in only one joint. Data regarding the metachronous PJI management for these patients are limited. This study aimed to explore the risk factors for metachronous PJI in patients with multiple prosthetic joints, thereby guiding and optimizing clinical practice.
The MEDLINE, Web of Science, Cochrane Library, and EMBASE were searched for all clinical studies of metachronous PJI from inception until May 2024. The clinical studies on risk factors for metachronous PJI in patients with multiple prosthetic joints after experiencing a periprosthetic infection were collected, with two authors independently screening the literatures. Newcastle Ottawa scale was used as a quality assessment tool for the included studies, and the meta-analysis was conducted to evaluate the potential risk factors of metachronous PJI.
A total of 1,544 patients with PJI after multiple joint arthroplasties were reported in 9 studies, including 189 with metachronous PJI. The meta-analysis showed that methicillin-resistant staphylococcus aureus (MRSA; OR, 3.43; 95%CI, 1.71-6.88; p = 0.0005), rheumatoid arthritis (RA; OR, 2.38; 95%CI, 1.06-5.38; p = 0.04), history of steroid use (OR, 2.93; 95%CI, 1.58-5.43; p = 0.0007), and previous or ongoing non-periprosthetic infection (OR, 4.47; 95%CI, 1.45-13.82; p = 0.009) were identified as significant risk factors for metachronous PJI in patients with multiple prosthetic joints. However, there was no significant difference between the metachronous PJI group and non-metachronous group in terms of revision, age, diabetes, and gender.
Patients with MRSA, RA, history of steroid use, previous or ongoing non-periprosthetic infection are at significantly higher risk for metachronous PJI. Further research is needed to optimize management strategies for preventing metachronous PJI in patients with multiple prostheses after a single joint PJI.
虽然人工关节周围感染（PJI）可同时累及多个关节，但大多数多关节受累的个体仅在一个关节出现PJI。关于这些患者异时性PJI治疗的数据有限。本研究旨在探讨多个人工关节患者异时性PJI的危险因素，从而指导和优化临床实践。
检索MEDLINE、科学网、Cochrane图书馆和EMBASE，查找从创刊至2024年5月的所有异时性PJI临床研究。收集人工关节周围感染后多个人工关节患者异时性PJI危险因素的临床研究，由两名作者独立筛选文献。采用纽卡斯尔渥太华量表作为纳入研究的质量评估工具，并进行荟萃分析以评估异时性PJI的潜在危险因素。
9项研究共报告了1544例多关节置换术后发生PJI的患者，其中189例发生异时性PJI。荟萃分析显示，耐甲氧西林金黄色葡萄球菌（MRSA；比值比[OR]，3.43；95%置信区间[CI]，1.71 - 6.88；p = 0.0005）、类风湿关节炎（RA；OR，2.38；95%CI，1.06 - 5.38；p = 0.04）、使用类固醇激素史（OR，2.93；95%CI，1.58 - 5.43；p = 0.0007）以及既往或正在发生的非人工关节周围感染（OR，4.47；95%CI，1.45 - 13.82；p = 0.009）被确定为多个人工关节患者异时性PJI的显著危险因素。然而，异时性PJI组与非异时性PJI组在翻修、年龄、糖尿病和性别方面无显著差异。
患有MRSA、RA、有使用类固醇激素史、既往或正在发生非人工关节周围感染的患者发生异时性PJI风险显著更高。需要进一步研究以优化单关节PJI后多个人工关节患者预防异时性PJI的管理策略。
