Long-Term Mortality Associated with Periprosthetic Infection in Total Hip Arthroplasty: A Registry Study of 4,651 Revisions for Infection.

IF 4.3 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-06-03 DOI:10.2106/JBJS.24.01629

David G Campbell, Joshua S Davis, Richard N de Steiger, Michelle F Lorimer, Dylan Harries, Ian A Harris, Laurens Manning, Peter L Lewis

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引用次数: 0

Abstract

Background: While the morbidity associated with revision total hip arthroplasty (THA) or periprosthetic infection (PJI) has been well characterized, less is known about the risk of mortality. With this study, we aimed to determine the long-term mortality associated with revision THA for PJI and associated risk factors.

Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used to study mortality associated with THA procedures for osteoarthritis and subsequent revisions from September 1999 through December 2022. Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables were used to summarize the overall survival following the primary and first revision THA. Risk factors associated with mortality were identified using Cox proportional hazards models, adjusted for age and gender.

Results: There were 548,061 primary THA procedures for osteoarthritis; 4,651 first revision procedures for infection and 15,891 first revisions for reasons other than infection and fracture were recorded. At 5, 10, and 15 years, the cumulative mortality rate for revision for PJI was 14.5%, 34.7%, and 57.5%, respectively. Patients who underwent revision for PJI had higher mortality rates than expected compared with the general population, and the corresponding SMR (1.31; 95% confidence interval [CI]: 1.24 to 1.39) was greater than that for patients undergoing primary THA (0.81; 95% CI: 0.81 to 0.82) or aseptic revision (0.95; 95% CI: 0.92 to 0.99). A higher SMR following revision for PJI was observed in patients <65 years of age and in female patients, and continued to increase beyond 15 years. There were no differences in mortality rates according to whether a major or minor revision was performed to manage PJI.

Conclusions: Patients revised for infection had increased mortality rates compared with the general population and those undergoing primary THA or aseptic revision. This excess risk persisted beyond 15 years, especially in younger patients.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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全髋关节置换术中与假体周围感染相关的长期死亡率：4651例感染修订的登记研究

背景：虽然与翻修全髋关节置换术（THA）或假体周围感染（PJI）相关的发病率已经有了很好的特征，但对死亡率的风险知之甚少。在这项研究中，我们旨在确定与PJI改良THA相关的长期死亡率和相关危险因素。方法：从1999年9月至2022年12月，来自澳大利亚骨科协会国家关节置换登记处（AOANJRR）的数据被用于研究骨关节炎THA手术及其后续修订的死亡率。基于澳大利亚周期生命表的Kaplan-Meier估计生存率和标准化死亡率（SMRs）用于总结第一次和第一次修订THA后的总生存率。使用Cox比例风险模型确定与死亡率相关的危险因素，并根据年龄和性别进行调整。结果：有548,061例骨关节炎的初级THA手术；记录了4651例感染的首次翻修手术和15891例非感染和骨折原因的首次翻修手术。在5年、10年和15年，PJI修正的累积死亡率分别为14.5%、34.7%和57.5%。与一般人群相比，接受PJI改良的患者死亡率高于预期，相应的SMR (1.31；95%可信区间[CI]: 1.24 ~ 1.39)大于原发性THA患者(0.81；95% CI: 0.81至0.82)或无菌修订(0.95；95% CI: 0.92 ~ 0.99)。结论：与普通人群和接受原发性THA或无菌翻修的患者相比，因感染翻修的患者死亡率增加。这种额外的风险持续超过15年，特别是在年轻患者中。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.