Abstract：
UNASSIGNED: This study aims to assess the relationship between history of pseudotumour formation secondary to metal-on-metal (MoM) implants and periprosthetic joint infection (PJI) rate, as well as establish ESR and CRP thresholds that are suggestive of infection in these patients. We hypothesized that patients with a pseudotumour were at increased risk of infection.
UNASSIGNED: A total of 1,171 total hip arthroplasty (THA) patients with MoM articulations from August 2000 to March 2014 were retrospectively identified. Of those, 328 patients underwent metal artefact reduction sequence MRI and had minimum two years\' clinical follow-up, and met our inclusion criteria. Data collected included demographic details, surgical indication, laterality, implants used, history of pseudotumour, and their corresponding preoperative ESR (mm/hr) and CRP (mg/dl) levels. Multivariate logistic regression modelling was used to evaluate PJI and history of pseudotumour, and receiver operating characteristic curves were created to assess the diagnostic capabilities of ESR and CRP to determine the presence of infection in patients undergoing revision surgery.
UNASSIGNED: The rate of PJI for all identified MoM THAs was 3.5% (41/1,171), with a mean follow-up of 10.9 years (2.0 to 20.4). Of the patients included in the final cohort, 8.2% (27/328) had PJI, with a mean follow-up of 12.2 years (2.3 to 20.4). Among this cohort, 31.1% (102/328) had a history of pseudotumour. The rate of PJI in these patients was 14.7% (15/102), which was greater than those without pseudotumour, 5.3% (12/226) (p = 0.008). Additionally, logistic regression analysis showed an association between history of pseudotumour and PJI (odds ratio 4.36 (95% confidence interval 1.77 to 11.3); p = 0.002). Optimal diagnostic cutoffs for PJI in patients with history of pseudotumour versus those without were 33.1 mm/hr and 24.5 mm/hr for ESR and 7.37 mg/dl and 1.88 mg/dl for CRP, respectively.
UNASSIGNED: Patients with history of pseudotumour secondary to MoM THA had a higher likelihood of infection than those without. While suspicion of infection should be high for these patients, ESR and CRP cutoffs published by the European Bone and Joint Infection Society may not be appropriate for patients with a history of pseudotumour, as ESR and CRP levels suggestive of PJI are likely to be higher than for those without a pseudotumour. Additional investigation, such as aspiration, is highly recommended for these patients unless clinical suspicion and laboratory markers are low.
UNASSIGNED: A total of 1,171 total hip arthroplasty (THA) patients with MoM articulations from August 2000 to March 2014 were retrospectively identified. Of those, 328 patients underwent metal artefact reduction sequence MRI and had minimum two years\' clinical follow-up, and met our inclusion criteria. Data collected included demographic details, surgical indication, laterality, implants used, history of pseudotumour, and their corresponding preoperative ESR (mm/hr) and CRP (mg/dl) levels. Multivariate logistic regression modelling was used to evaluate PJI and history of pseudotumour, and receiver operating characteristic curves were created to assess the diagnostic capabilities of ESR and CRP to determine the presence of infection in patients undergoing revision surgery.
UNASSIGNED: The rate of PJI for all identified MoM THAs was 3.5% (41/1,171), with a mean follow-up of 10.9 years (2.0 to 20.4). Of the patients included in the final cohort, 8.2% (27/328) had PJI, with a mean follow-up of 12.2 years (2.3 to 20.4). Among this cohort, 31.1% (102/328) had a history of pseudotumour. The rate of PJI in these patients was 14.7% (15/102), which was greater than those without pseudotumour, 5.3% (12/226) (p = 0.008). Additionally, logistic regression analysis showed an association between history of pseudotumour and PJI (odds ratio 4.36 (95% confidence interval 1.77 to 11.3); p = 0.002). Optimal diagnostic cutoffs for PJI in patients with history of pseudotumour versus those without were 33.1 mm/hr and 24.5 mm/hr for ESR and 7.37 mg/dl and 1.88 mg/dl for CRP, respectively.
UNASSIGNED: Patients with history of pseudotumour secondary to MoM THA had a higher likelihood of infection than those without. While suspicion of infection should be high for these patients, ESR and CRP cutoffs published by the European Bone and Joint Infection Society may not be appropriate for patients with a history of pseudotumour, as ESR and CRP levels suggestive of PJI are likely to be higher than for those without a pseudotumour. Additional investigation, such as aspiration, is highly recommended for these patients unless clinical suspicion and laboratory markers are low.
摘要：
■本研究旨在评估金属对金属（MoM）植入物继发的假瘤形成史与假体周围感染（PJI）率之间的关系，以及建立提示这些患者感染的ESR和CRP阈值。我们假设假瘤患者的感染风险增加。
■回顾性分析了2000年8月至2014年3月共有1,171例MoM关节全髋关节置换术(THA)患者。其中,328例患者接受了金属伪影减少序列MRI检查，并进行了至少两年的临床随访，符合我们的入选标准.收集的数据包括人口统计细节，手术适应症,偏侧性,使用的植入物，假瘤的历史,和相应的术前ESR（mm/hr）和CRP（mg/dl）水平。多因素logistic回归模型用于评估PJI和假瘤病史，建立受试者工作特征曲线,以评估ESR和CRP的诊断能力,从而确定翻修手术患者是否存在感染.
■所有确定的MoMTHA的PJI率为3.5％（41/1,171），平均随访10.9年（2.0至20.4年）。在最终队列中的患者中，8.2%(27/328)患有PJI，平均随访12.2年（2.3至20.4年）。在这个群体中，31.1％（102/328）有假瘤史。这些患者的PJI率为14.7%(15/102),比没有假瘤的人更大，5.3%(12/226)(p=0.008)。此外,logistic回归分析显示假瘤病史与PJI之间存在关联(比值比4.36(95%置信区间1.77~11.3);p=0.002).在有假瘤病史的患者中，与没有假瘤病史的患者相比，PJI的最佳诊断截止值ESR为33.1mm/hr和24.5mm/hr，CRP为7.37mg/dl和1.88mg/dl，分别。
■有MoMTHA继发假瘤病史的患者比没有假瘤病史的患者有更高的感染可能性。虽然这些患者对感染的怀疑应该很高，欧洲骨与关节感染协会公布的ESR和CRP截止值可能不适用于有假瘤病史的患者。因为提示PJI的ESR和CRP水平可能高于无假瘤患者.额外的调查,如愿望，除非临床怀疑和实验室标志物低，否则强烈建议这些患者。
■回顾性分析了2000年8月至2014年3月共有1,171例MoM关节全髋关节置换术(THA)患者。其中,328例患者接受了金属伪影减少序列MRI检查，并进行了至少两年的临床随访，符合我们的入选标准.收集的数据包括人口统计细节，手术适应症,偏侧性,使用的植入物，假瘤的历史,和相应的术前ESR（mm/hr）和CRP（mg/dl）水平。多因素logistic回归模型用于评估PJI和假瘤病史，建立受试者工作特征曲线,以评估ESR和CRP的诊断能力,从而确定翻修手术患者是否存在感染.
■所有确定的MoMTHA的PJI率为3.5％（41/1,171），平均随访10.9年（2.0至20.4年）。在最终队列中的患者中，8.2%(27/328)患有PJI，平均随访12.2年（2.3至20.4年）。在这个群体中，31.1％（102/328）有假瘤史。这些患者的PJI率为14.7%(15/102),比没有假瘤的人更大，5.3%(12/226)(p=0.008)。此外,logistic回归分析显示假瘤病史与PJI之间存在关联(比值比4.36(95%置信区间1.77~11.3);p=0.002).在有假瘤病史的患者中，与没有假瘤病史的患者相比，PJI的最佳诊断截止值ESR为33.1mm/hr和24.5mm/hr，CRP为7.37mg/dl和1.88mg/dl，分别。
■有MoMTHA继发假瘤病史的患者比没有假瘤病史的患者有更高的感染可能性。虽然这些患者对感染的怀疑应该很高，欧洲骨与关节感染协会公布的ESR和CRP截止值可能不适用于有假瘤病史的患者。因为提示PJI的ESR和CRP水平可能高于无假瘤患者.额外的调查,如愿望，除非临床怀疑和实验室标志物低，否则强烈建议这些患者。
