Campbell David G, Davis Joshua S, de Steiger Richard N, Lorimer Michelle F, Harries Dylan, Harris Ian A, Manning Laurens, Lewis Peter L
Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia.
Wakefield Orthopaedic Clinic, Adelaide, Australia.
J Bone Joint Surg Am. 2025 Jun 3;107(14):1620-1627. doi: 10.2106/JBJS.24.01629.
While the morbidity associated with revision total hip arthroplasty (THA) or periprosthetic infection (PJI) has been well characterized, less is known about the risk of mortality. With this study, we aimed to determine the long-term mortality associated with revision THA for PJI and associated risk factors.
Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used to study mortality associated with THA procedures for osteoarthritis and subsequent revisions from September 1999 through December 2022. Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables were used to summarize the overall survival following the primary and first revision THA. Risk factors associated with mortality were identified using Cox proportional hazards models, adjusted for age and gender.
There were 548,061 primary THA procedures for osteoarthritis; 4,651 first revision procedures for infection and 15,891 first revisions for reasons other than infection and fracture were recorded. At 5, 10, and 15 years, the cumulative mortality rate for revision for PJI was 14.5%, 34.7%, and 57.5%, respectively. Patients who underwent revision for PJI had higher mortality rates than expected compared with the general population, and the corresponding SMR (1.31; 95% confidence interval [CI]: 1.24 to 1.39) was greater than that for patients undergoing primary THA (0.81; 95% CI: 0.81 to 0.82) or aseptic revision (0.95; 95% CI: 0.92 to 0.99). A higher SMR following revision for PJI was observed in patients <65 years of age and in female patients, and continued to increase beyond 15 years. There were no differences in mortality rates according to whether a major or minor revision was performed to manage PJI.
Patients revised for infection had increased mortality rates compared with the general population and those undergoing primary THA or aseptic revision. This excess risk persisted beyond 15 years, especially in younger patients.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
虽然翻修全髋关节置换术（THA）或假体周围感染（PJI）相关的发病率已得到充分描述，但关于死亡率风险的了解较少。通过本研究，我们旨在确定因PJI进行翻修THA的长期死亡率及相关危险因素。
利用澳大利亚骨科协会国家关节置换登记处（AOANJRR）的数据，研究1999年9月至2022年12月期间骨关节炎THA手术及后续翻修相关的死亡率。采用Kaplan-Meier生存估计和基于澳大利亚时期生命表的标准化死亡率比（SMR）来总结初次和首次翻修THA后的总体生存率。使用Cox比例风险模型确定与死亡率相关的危险因素，并对年龄和性别进行调整。
记录了548,061例骨关节炎初次THA手术；4,651例因感染进行的首次翻修手术，以及15,891例因感染和骨折以外原因进行的首次翻修手术。在5年、10年和15年时，PJI翻修的累积死亡率分别为14.5%、34.7%和57.5%。与一般人群相比，因PJI接受翻修的患者死亡率更高，相应的SMR（1.31；95%置信区间[CI]：1.24至1.39）高于初次THA患者（0.81；95%CI：0.81至0.82）或无菌翻修患者（0.95；95%CI：0.92至0.99）。在年龄<65岁的患者和女性患者中，PJI翻修后的SMR更高，且在15年后继续上升。根据处理PJI时进行的是大翻修还是小翻修，死亡率没有差异。
与一般人群以及接受初次THA或无菌翻修的患者相比，因感染接受翻修的患者死亡率增加。这种额外风险在15年后仍然存在，尤其是在年轻患者中。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
