Puelacher Christian, Stuetzle Adrian, Morgenstern Mario, Sendi Parham, Mueller Christian, Clauss Martin
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria.
Bone Joint J. 2025 Aug 1;107-B(8):821-828. doi: 10.1302/0301-620X.107B8.BJJ-2025-0048.R1.
The aim of this study was to analyze the risk of perioperative adverse outcomes, including perioperative myocardial injury and infarction (PMI), major adverse cardiac events (MACE), and mortality, which are associated with revision for periprosthetic joint infection (PJI) compared with primary arthroplasty and aseptic revision surgery.
This was a post-hoc analysis of the BASEL-PMI study (NCT02573532). The study included patients from one tertiary care centre who underwent primary total hip (THA) or knee (TKA) arthroplasty, and revision THA and TKA. Patients were included if they had established cardiovascular comorbidities or were aged ≥ 65 years, and were eligible for our institutional PMI screening and response programme. High-sensitivity cardiac troponin T levels were measured preoperatively and on postoperative days one and two. The primary endpoint was the incidence of PMI, and secondary endpoints included the rates of all-cause mortality and MACE at 120 days postoperatively.
Between May 2014 and February 2018, 673 patients were included in the study, of whom 443 underwent primary THA or TKA, 111 underwent aseptic revision, and 119 underwent revision for PJI. PMI occurred in 120 patients (18%) overall, with higher rates in revisions (23; 21%) in the aseptic and 42 (35%) in the PJI groups) compared with 55 (12%) in the primary arthroplasty group. All-cause mortality was significantly increased in patients who underwent revision for PJI (9%) compared with aseptic revision (4%) and primary arthroplasty (2%). The rates of MACE were also increased in revisions, particularly in those for PJI (12%). Multivariable analysis showed an odds ratio of 2.9 (95% CI 1.7 to 5.2) for PMI in revisions for PJI.
Patients who underwent revision arthroplasty had significantly increased risks of PMI, MACE, and mortality compared with those who underwent primary arthroplasty. In revision surgery, revision for PJI showed an especially high risk of cardiovascular complications.
本研究旨在分析与初次关节置换术和无菌性翻修手术相比，假体周围关节感染（PJI）翻修术相关的围手术期不良结局风险，包括围手术期心肌损伤和梗死（PMI）、主要不良心脏事件（MACE）及死亡率。
这是对BASEL - PMI研究（NCT02573532）的事后分析。该研究纳入了来自一家三级医疗中心接受初次全髋关节置换术（THA）或全膝关节置换术（TKA）以及THA和TKA翻修术的患者。若患者患有已确诊的心血管合并症或年龄≥65岁，且符合我们机构的PMI筛查和应对计划，则纳入研究。术前以及术后第1天和第2天测量高敏心肌肌钙蛋白T水平。主要终点是PMI的发生率，次要终点包括术后120天的全因死亡率和MACE发生率。
2014年5月至2018年2月期间，673例患者纳入研究，其中443例行初次THA或TKA，111例行无菌性翻修，119例行PJI翻修。总体上，120例患者（18%）发生PMI，与初次关节置换术组的55例（12%）相比，无菌性翻修组的23例（21%）和PJI组的42例（35%）发生率更高。接受PJI翻修术的患者全因死亡率（9%）显著高于无菌性翻修术患者（4%）和初次关节置换术患者（2%）。翻修术患者的MACE发生率也有所增加，尤其是PJI翻修术患者（12%）。多变量分析显示，PJI翻修术患者发生PMI的比值比为2.9（95%CI 1.7至5.2）。
与接受初次关节置换术的患者相比，接受翻修关节置换术的患者发生PMI、MACE和死亡的风险显著增加。在翻修手术中，PJI翻修术显示出特别高的心血管并发症风险。
