Fröschen Frank Sebastian, Greber Lisa, Molitor Ernst, Hischebeth Gunnar Thorben Rembert, Franz Alexander, Randau Thomas Martin
Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, 53127 Bonn, Germany.
Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, 53127 Bonn, Germany.
Infect Dis Rep. 2025 May 15;17(3):54. doi: 10.3390/idr17030054.
Periprosthetic joint infections (PJIs) remain a major challenge in arthroplasty. This study tries to evaluate the PJI-TNM classification as predictor for the revision-free implant survival in patients with PJI of the hip or knee joint.
To this end, we perform a retrospective study of all consecutive patients with PJI of an inlying hip or knee arthroplasty between January 2015 and December 2019.
A total of 443 cases (hip: = 247; knee = 196) were identified. In total, 439 patients underwent surgery (DAIR: = 138 cases (31%), explantation: = 272 (61%), irrigation with debridement without exchange of implant components: = 29 (6.5%)). Four patients refused surgical treatment and 39.5% were lost to follow-up. In total, 78 patients died during follow-up and 27 deaths were directly related to PJI/complications during treatment. Patients with inlying "standard"-implants ( < 0.001) and without previous history of PJI ( = 0.002) displayed a significantly higher postoperative revision-free implant survival. In terms of the PJI-TNM subclassification, patients with loosened implants but without soft-tissue defects (T1) displayed the highest revision-free implant survival. In contrast, patients classified as M3 (no surgical treatment possible) displayed an inferior outcome compared to M0, M1, or M2. Patients with different N-subclassifications ("non-human cells"/causative pathogen) did not display differences in revision-free implant survival.
The PJI-TNM classification is well suited to classify PJIs. Its complexity allows for more than 500 different combinations of classifications. Further validation data are needed, but to us, the PJI-TNM classification seems to offer the possibility of comparing patients with PJIs. It may, therefore, be a very valuable tool in order to compare cohorts with PJIs and provide individual data for patient specific outcomes.
人工关节周围感染（PJI）仍是关节置换术中的一项重大挑战。本研究旨在评估PJI-TNM分类作为髋关节或膝关节PJI患者无翻修植入物生存率预测指标的价值。
为此，我们对2015年1月至2019年12月期间所有连续的髋关节或膝关节置换术后发生PJI的患者进行了一项回顾性研究。
共确定443例（髋关节：247例；膝关节：196例）。总计439例患者接受了手术（清创并保留植入物：138例（31%），取出植入物：272例（61%），清创冲洗但不更换植入物组件：29例（6.5%））。4例患者拒绝手术治疗，39.5%的患者失访。随访期间共有78例患者死亡，27例死亡与治疗期间的PJI/并发症直接相关。植入“标准”植入物（P<0.001）且无前PJI病史（P = 0.002）的患者术后无翻修植入物生存率显著更高。就PJI-TNM亚分类而言，植入物松动但无软组织缺损（T1）的患者无翻修植入物生存率最高。相比之下，分类为M3（无法进行手术治疗）的患者与M0、M1或M2患者相比，预后较差。不同N亚分类（“非人体细胞”/致病病原体）的患者在无翻修植入物生存率方面没有差异。
PJI-TNM分类非常适合对PJI进行分类。其复杂性允许有500多种不同的分类组合。需要进一步的验证数据，但对我们来说，PJI-TNM分类似乎提供了比较PJI患者的可能性。因此，它可能是比较PJI队列并为患者特定结局提供个体数据的非常有价值的工具。
