Chao Richard, Rothenberger Scott D, Plate Johannes F, Klatt Brian A, Shah Neel B, Urish Kenneth L
Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Arthroplasty. 2025 Sep;40(9S1):S502-S506. doi: 10.1016/j.arth.2024.08.048. Epub 2024 Nov 12.
Periprosthetic joint infection (PJI) is a leading cause of total knee arthroplasty (TKA) failure. Debridement, antibiotics, and implant retention (DAIR) is the preferred treatment for acute PJI. The objectives of this study were to determine the length of time TKA PJIs should be monitored after DAIR and the time point where the majority of PJI treatment failure occurs.
This study, spanning 2005 to 2022, involved 108 patients from 16 hospitals within a regional health system. Patients had an average follow-up of 9.8 years. Bayesian regression with Monte Carlo Markov Chain simulation was employed to identify significant breakpoints in cumulative failure curves.
Our single and double breakpoint models identified significant decreases in the failure rates at 1.02 and 0.92 years for the entire cohort, respectively. Our double breakpoint model also identified 4.49 years as a point of significant decrease in failure rate.
This study suggests that most failures for acute TKA PJI treated with DAIR occur within one year, with significant breakpoints identified at approximately one and five years. Our results suggest monitoring these patients between a range of one and five years.
人工关节周围感染（PJI）是全膝关节置换术（TKA）失败的主要原因。清创、抗生素治疗和保留植入物（DAIR）是急性PJI的首选治疗方法。本研究的目的是确定DAIR治疗后TKA PJI应监测的时间长度以及大多数PJI治疗失败发生的时间点。
本研究涵盖2005年至2022年，涉及区域卫生系统内16家医院的108名患者。患者的平均随访时间为9.8年。采用贝叶斯回归和蒙特卡洛马尔可夫链模拟来确定累积失败曲线中的显著断点。
我们的单断点和双断点模型分别确定整个队列在1.02年和0.92年时失败率显著下降。我们的双断点模型还确定4.49年为失败率显著下降的时间点。
本研究表明，接受DAIR治疗的急性TKA PJI的大多数失败发生在一年内，在大约一年和五年时确定了显著断点。我们的结果表明应在一至五年的时间范围内对这些患者进行监测。
