不明确和假定无菌髋关节和膝关节翻修关节置换术中意外的术中培养阳性结果的发生率、风险因素、微生物学结果和临床结果 - 一项至少随访两年的十年回顾性分析

IF 5.9 1区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Translation Pub Date : 2024-08-17 DOI:10.1016/j.jot.2024.08.002

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引用次数: 0

摘要

背景本研究旨在评估与培养阴性（CN）翻修相比，假定无菌和不明确的翻修全髋/膝关节置换术（rTHA 和 rTKA）中意外阳性术中培养（UPIC）的发生率、微生物谱、风险因素和临床结局。方法本研究回顾了 2011 年至 2020 年在我院进行的所有培养阴性或不明确的 rTHA（n = 751）和 rTKA（n = 679），随访时间至少两年。我们采用卡普兰-梅耶尔分析法确定了UPIC病例和相匹配的培养阴性病例的败血症和无菌植入存活率。结果与 rTKA 的 113/679 例（16.6%）相比，rTHA 的 UPIC 例数明显更多，为 196/751 例（26.1%）；（p <0.001）。与CN翻修相比，rTKA和rTHA的UPIC化脓性和无菌植入物存活率较低。有镍过敏史的患者在rTHA和rTKA中发生UPIC的风险更高（p < 0.001）。与UPIC术后无菌性再次翻修的患者相比，UPIC术后化脓性再次翻修的患者距离初次/前次手术的时间明显较短（H：p = 0.004；K：p = 0.030）（H：84（IQR：41-797）；K：115（IQR：55-446））（H：1248（IQR：178-3534）；K：827（IQR：361-1183））。结论UPIC的脓毒性和无菌性失败率高于CN结果。与 rTKA 相比，UPIC 在 rTHA 中的发生率是后者的两倍。术前PJI检查可降低UPIC发生率。镍过敏是UPIC的一个风险因素。本文的转化潜力本文就UPIC的翻修率和UPIC及其治疗失败的潜在风险因素提供了新的信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Prevalence, risk factors, microbiological results and clinical outcome in unexpected positive intraoperative cultures in unclear and presumed aseptic hip and knee revision arthroplasties – A ten-year retrospective analysis with a minimum follow up of 2 years

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Background

The aim of this study was to assess the prevalence, microbiological spectrum, risk factors, and clinical outcomes of unexpected-positive-intraoperative-cultures (UPIC) in presumed aseptic and unclear revision-total-hip-/knee-arthroplasties (rTHA and rTKA) compared to culture-negative (CN) revisions.

Methods

This study reviewed all International-consensus-meeting-2018 (ICM 2018) negative or inconclusive rTHA (n = 751) and rTKA (n = 679) performed at our institution from 2011 to 2020 with a minimum follow-up of two years. A Kaplan-Meier-analysis was performed to determine the septic and aseptic-free implant survival in cases with UPIC's and matched culture-negative cases. Patient demographics, risk factors, microbiological spectrum and clinical outcomes were evaluated.

Results

There were significantly more UPIC cases in rTHA 196/751 (26.1 %) compared to rTKA 113/679 (16.6 %); (p < 0.001). UPICs in rTKA and rTHA have a lower septic and aseptic implant-free-survival compared to CN revisions. Patients with a history of nickel allergy have a higher risk of an UPIC in rTHA and rTKA (p < 0.001). Septic re-revisions after UPIC had a significantly (H: p = 0.004; K: p = 0.030) shorter time period to the primary/previous surgery (H: 84 (IQR:41–797); K: 115 (IQR:55–446)) compared to patients with aseptic re-revisions after UPIC (H:1248 (IQR:178-3534); K: 827 (IQR:361-1183)).

Conclusion

UPICs have a higher rate of septic and aseptic failure than CN outcomes. UPICs are twice as common in rTHA compared to rTKA. Preoperative PJI workup reduces the UPIC rate. Nickel allergy is a risk factor for UPIC. Early revisions with UPICs after primary THA or TKA have a higher risk of septic failure.

The translational potential of this article

This article provides new information on revision rates for UPIC and potential risk factors for UPIC and its treatment failure.

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来源期刊

Journal of Orthopaedic Translation Medicine-Orthopedics and Sports Medicine

CiteScore

11.80

自引率

13.60%

发文量

审稿时长

29 days

期刊介绍： The Journal of Orthopaedic Translation (JOT) is the official peer-reviewed, open access journal of the Chinese Speaking Orthopaedic Society (CSOS) and the International Chinese Musculoskeletal Research Society (ICMRS). It is published quarterly, in January, April, July and October, by Elsevier.