目的:髋部化脓性关节炎常导致不可逆的骨关节炎(OA)和需要全髋关节置换术(THA)。这项研究的目的是报告任何感染的中期风险,假体周围关节感染(PJI),无菌翻修,对有化脓性关节炎病史并接受THA的患者进行再次手术,与接受THA治疗OA的对照组患者相比。
方法:我们回顾性地确定了244例天然髋部化脓性关节炎患者中的256例THA,这是在1969年至2016年之间在一个机构进行的。每个病例根据年龄1:1匹配,性别,BMI,和手术年份,为OA进行的主要THA。平均年龄和BMI分别为58岁(35至84)和31kg/m2(18至48),分别,100人(39%)为女性。平均随访时间为11年(2至39年)。
结果:在化脓性关节炎和OA组中,无任何感染的十年生存率分别为91%和99%,分别(风险比(HR)=13;p<0.001)。在化脓性关节炎和OA组中,十年无PJI的生存率分别为93%和99%。分别(HR=10;p=0.002)。在诊断为脓毒性关节炎的五年内进行THA的十年内,任何感染率明显高于在诊断后五年内进行THA的患者(14%vs5%,分别为;HR=3.1;p=0.009),但无无菌翻修的10年生存率无显著差异(HR=1.14;p=0.485).与OA组相比,化脓性关节炎组术后2年和5年的平均Harris髋关节评分均显着降低(两者的p=0.001)。
结论:与因OA而接受THA的患者相比,有化脓性关节炎病史的患者发生PJI的风险增加了10倍,10年累积发生率为7%。任何感染的风险都有强烈的下降趋势,因为诊断为脓毒性关节炎和THA之间的时间间隔增加,在诊断后五年内进行THA时,风险高3.1倍。引用本文:骨关节J2022;104-B(2):227-234。
OBJECTIVE: Septic arthritis of the hip often leads to irreversible osteoarthritis (OA) and the requirement for total hip arthroplasty (THA). The aim of this study was to report the mid-term risk of any infection, periprosthetic joint infection (PJI), aseptic revision, and reoperation in patients with a past history of septic arthritis who underwent THA, compared with a control group of patients who underwent THA for OA.
METHODS: We retrospectively identified 256 THAs in 244 patients following septic arthritis of the native hip, which were undertaken between 1969 and 2016 at a single institution. Each
case was matched 1:1, based on age, sex, BMI, and year of surgery, to a primary THA performed for OA. The mean age and BMI were 58 years (35 to 84) and 31 kg/m2 (18 to 48), respectively, and 100 (39%) were female. The mean follow-up was 11 years (2 to 39).
RESULTS: The ten-year survival free of any infection was 91% and 99% in the septic arthritis and OA groups, respectively (hazard ratio (HR) = 13; p < 0.001). The survival free of PJI at ten years was 93% and 99% in the septic arthritis and OA groups, respectively (HR = 10; p = 0.002). There was a significantly higher rate of any infection at ten years when THA was undertaken within five years of the diagnosis of septic arthritis compared with those in whom THA was undertaken > five years after this diagnosis was made (14% vs 5%, respectively; HR = 3.1; p = 0.009), but there was no significant difference in ten-year survival free of aseptic revision (HR = 1.14; p = 0.485). The mean Harris Hip Scores at two and five years postoperatively were significantly lower in the septic arthritis group compared with the OA group (p = 0.001 for both).
CONCLUSIONS: There was a ten-fold increased risk of PJI in patients with a history of septic arthritis who underwent THA compared with those who underwent THA for OA with a ten-year cumulative incidence of 7%. The risk of any infection had a strong downward trend as the time interval between the diagnosis of septic arthritis and THA increased, highlighted by a 3.1-fold higher risk when THAs were performed within five years of the diagnosis being made. Cite this article: Bone Joint J 2022;104-B(2):227-234.