背景:假体周围感染(PJI)是全膝关节置换术(TKA)后的破坏性并发症。几乎没有证据将那些与PJI早期和晚期进行比较。该研究的目的是确定早期和晚期PJI患者之间的合并症特征差异。
方法:从2009年至2021年,有72,659名患者接受了原发性TKA,这些患者是从商业索赔和遭遇数据库中确定的。诊断为PJI的受试者分为“早期”(索引程序90天内)或“晚期”(索引关节成形术后>2年)。在这些相同时期内的未感染患者作为对照组,遵循与其他外来变量匹配的4:1倾向评分。进行Logistic回归分析,比较各组间的合并症。
结果:与早期感染组相比,患者在晚期明显年轻(58.1岁对62.4岁,P<0.001)。与那些早期PJI相比,患有慢性肾脏病的患者(13.3对4.1%;OR[比值比]5.17,P=0.002),恶性肿瘤(20.4%对10.5%;OR2.53,P=0.009),单纯性糖尿病(40.8对30.6%;OR2.00,P=0.01),类风湿性关节炎(9.2对3.3%;OR2.66,P=0.046),高血压(88.8对81.6%;OR2.17,P=0.04)都是晚期PJI的重要预测因子。
结论:与原发性TKA后诊断为早期PJI的患者相比,慢性肾病的存在,恶性肿瘤,简单的糖尿病,类风湿性关节炎,高血压是PJI晚期发生的独立危险因素。有这些合并症的年轻患者可能是术前优化干预措施的目标,以最大程度地降低PJI的风险。
BACKGROUND: Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Little evidence exists comparing those with early versus late PJI. The purpose of the study was to determine comorbidity profile differences between patients developing early and late PJI.
METHODS: There were 72,659 patients undergoing primary TKA from 2009 to 2021, who were identified from a commercial claims and encounters database. Subjects diagnosed with PJI were categorized as either \'early\' (within 90 days of index procedure) or \'late\' (> 2 years after index arthroplasty). Non-infected patients within these periods served as control groups following 4:1 propensity score matching on other extraneous variables. Logistic regression analyses were performed comparing comorbidities between groups.
RESULTS: Patients were significantly younger in the late compared to the early infection group (58.1 versus 62.4 years, P < .001). When compared to those with early PJI, patients who had chronic kidney disease (13.3 versus 4.1%; OR [odds ratio] 5.17, P = .002), malignancy (20.4 versus 10.5%; OR 2.53, P = .009), uncomplicated diabetes (40.8 versus 30.6%; OR 2.00, P = .01), rheumatoid arthritis (9.2 versus 3.3%; OR 2.66, P = .046), and hypertension (88.8 versus 81.6%; OR 2.17, P = .04), were all significant predictors of developing a late PJI.
CONCLUSIONS: When compared to patients diagnosed with early PJI following primary TKA, the presence of chronic kidney disease, malignancy, uncomplicated diabetes, rheumatoid arthritis, and hypertension, were independent risk factors for the development of late PJI. Younger patients who have these comorbidities may be targets for preoperative optimization interventions that minimize the risk of PJI.