Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis.
Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis.
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DOI：
10.1002/art.24060
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发表时间：
2008-12-15
影响因子：
--
通讯作者：
Matteson, Eric L.
中科院分区：
文献类型：
--
作者：
Bongartz, Tim;Halligan, Christine S.;Osmon, Douglas R.;Reinalda, Megan S.;Bamlet, William R.;Crowson, Cynthia S.;Hanssen, Arlen D.;Matteson, Eric L.
人工关节感染是全关节置换术后最可怕的并发症之一，全关节置换是类风湿性关节炎 (RA) 患者的常见手术。我们进行了一项研究来评估假体关节感染的潜在危险因素，并阐明 RA 是否是该并发症的独立预测因素。这项研究包括 1996 年 1 月至 2004 年 6 月期间在罗切斯特梅奥诊所接受全髋关节或膝关节置换术的所有 RA 患者。使用 Cox 模型检查了潜在危险因素与假体关节感染的关联。收集了一组匹配的骨关节炎 (OA) 患者，以确定 RA 是否是假体关节感染的独立危险因素。我们确定了 462 名 RA 患者，他们总共接受了 657 例髋关节或膝关节置换术。总体而言，在 4.3 ± 2.4 年的平均值 ± SD 随访期间，有 23 例 (3.7%) 关节置换术并发感染。翻修性关节置换术（风险比 [HR] 2.99，95% 置信区间 [95% CI] 1.02–8.75）和置换关节既往假体关节感染（HR 5.49，95% CI 1.87–16.14）是术后假体关节感染的重要预测因素。将 RA 患者与匹配的 OA 患者队列进行比较，发现 RA 患者的假体关节感染风险增加（HR 4.08，95% CI 1.35–12.33）。接受全髋关节或膝关节置换术的 RA 患者发生假体关节感染的风险增加，在翻修关节置换术和既往假体关节感染的情况下，这种风险进一步增加。这些发现强调了围手术期预防措施和术后保持警惕的重要性。
Prosthetic joint infection is one of the most dreaded complications after total joint arthroplasty, a common procedure in patients with rheumatoid arthritis (RA). We conducted a study to evaluate potential risk factors of prosthetic joint infection and to clarify if RA is an independent predictor of this complication. This study included all patients with RA who underwent total hip or knee replacement at the Mayo Clinic Rochester between January 1996 and June 2004. The association of potential risk factors with prosthetic joint infection was examined using Cox models. A matched cohort of patients with osteoarthritis (OA) was assembled to determine whether RA is an independent risk factor for prosthetic joint infection. We identified 462 patients with RA who underwent a total of 657 hip or knee replacements. Overall, 23 (3.7%) joint arthroplasties were complicated by an infection during a mean ± SD followup of 4.3 ± 2.4 years. Revision arthroplasty (hazard ratio [HR] 2.99, 95% confidence interval [95% CI] 1.02–8.75) and a previous prosthetic joint infection of the replaced joint (HR 5.49, 95% CI 1.87–16.14) were significant predictors of postoperative prosthetic joint infection. Comparison of RA patients with a matched cohort of OA patients identified an increased risk of prosthetic joint infections (HR 4.08, 95% CI 1.35–12.33) in patients with RA. Patients with RA who undergo total hip or knee replacement are at increased risk of prosthetic joint infection, which is further increased in the setting of revision arthroplasty and a previous prosthetic joint infection. These findings highlight the importance of perioperative prophylactic measures and vigilance during the postoperative period.
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