Risk Factors for Prosthetic Joint Infection after Primary Hip Arthroplasty

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Prosthetic joint infection (PJI) after primary hip arthroplasty (PHA) in most cases results in severe surgical and socio-economic problems. Along with improving the technical support of arthroplasty and antibiotic prevention schemes, a key point in reducing the rate of infectious complications is predicting of PJI in each individual patient. The purpose of the study was to reveal the key features of our patients with infectious complications after PHA in comparison with the patients with a successful outcome of arthroplasty. Materials and Methods. The outcomes of 249 cases of PHA were evaluated retrospectively. 115 of them subsequently developed PJI (main group) and 134 were without infectious complications (control group). The comparative analysis of the groups was aimed at identifying the key preoperative, intraoperative and postoperative factors for PJI, as well as combinations of the factors characteristic for our patients. Results. The risk group for the development of infectious complications included patients undergone hip surgery (p<0.001), body mass index >40 kg/m2 (p = 0.170), preoperative hemoglobin <115 g/L (p = 0.063), duration of the operation >90 min (p<0.001), intraoperative blood loss >410 ml (p<0.001), CRP >69 mg/L on day 4 th to 5 th after PHA (p<0.001), as well as a combination of 4 or more of the above factors (p<0.001). Conclusion. We believe that the correction of the management tactics of such patients taking into account the identified risk factors will reduce the incidence of PJI after PHA.

作者简介

A. Myasoedov

Vreden National Medical Research Center of Traumatology and Orthopedics

编辑信件的主要联系方式.
Email: aamyasoedov@rniito.ru

Alexey A. Myasoedov — Cand. Sci. (Med.), Researcher

St. Petersburg

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S. Toropov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Sergey S. Toropov — Orthopaediс Surgeon

St. Petersburg

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G. Berezin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Georgiy V. Berezin — Assistant Researcher

St. Petersburg

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V. Karelkin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Vitaliy V. Karelkin — Cand. Sci. (Med.), Head of Department

St. Petersburg

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Z. Totoev

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Zaurbek A. Totoev — Assistant Researcher

St. Petersburg

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I. Shubnyakov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Igor I. Shubnyakov — Dr. Sci. (Med.), Chief Researcher

St. Petersburg

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R. Tikhilov

Vreden National Medical Research Center of Traumatology and Orthopedics; Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Rashid M. Tikhilov — Dr. Sci. (Med.), Professor, Director, Vreden National Medical Research Center of Traumatology and Orthopedics; Professor, Traumatology and Orthopedics Department, Mechnikov North-Western State Medical University

St. Petersburg

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参考

  1. Maradit Kremers H., Larson D.R., Crowson C.S., Kremers W.K., Washington R.E., Steiner C.A. et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015;97(17):1386-1397. doi: 10.2106/JBJS.N.01141.
  2. Шубняков И.И., Тихилов Р.М., Николаев Н.С., Григоричева Л.Г., Овсянкин А.В., Черный А.Ж. и др. Эпидемиология первичного эндопротезирования тазобедренного сустава на основании денных регистра артропластики РНИИТО им. Р.Р. Вредена. Травматология и ортопедия России. 2017;23(2): 81-101. doi: 10.21823/2311-2905-2017-23-2-81-101.
  3. Тихилов Р.М., Шубняков И.И., Мясоедов А.А., Плиев Д.Г., Карелкин В.В., Березин Г.В. Эндопротезирование тазобедренного сустава при костных анкилозах различной этиологии, причины и результаты. Современные проблемы науки и образования. 2018;(2). Режим доступа: https://www.science-education.ru/ru/article/view?id=27426. doi: 10.17513/spno.27426.
  4. Коваленко А.Н., Шубняков И.И., Тихилов Р.М., Чёрный А.Ж. Обеспечивают ли новые и более дорогие имплантаты лучший результат эндопротезирования тазобедренного сустава? Травматология и ортопедия России. 2015;(1):5-20. doi: 10.21823/2311-2905-2015-0-1-30-36.
  5. Afzal I., Radha S., Smoljanović T., Stafford G.H., Twyman R., Field R.E. Validation of revision data for total hip and knee replacements undertaken at a high volume orthopaedic centre against data held on the National Joint Registry. J Orthop Surg Res. 2019;14(1):318. doi: 10.1186/s13018-019-1304-1309.
  6. Pabinger C., Lothaller H., Portner N., Geissler A. Projections of hip arthroplasty in OECD countries up to 2050. Hip Int. 2018;28(5):498-506. doi: 10.1177/1120700018757940.
  7. Материалы Второй международной с ной конференции по скелетно-мышечной инфекции / пер. с англ. ; под общ. ред. Р.М. Тихилова, С.А. Божковой, И.И. Шубнякова. СПб. : РНИИТО им. Р.Р. Вредена, 2019. 314 с. ISBN 978-5-6040358-0-1.
  8. Varnum C. Outcomes of different bearings in total hip arthroplasty – implant survival, revision causes, and patient-reported outcome. Dan Med J. 2017;64(3). pii: B5350.
  9. Шубняков И.И., Тихилов Р.М., Денисов А.О., Ахмедилов М.А., Черный А.Ж., Тотоев З.А. и др. Что изменилось в структуре ревизионного эндопротезирования тазобедренного сустава в последние годы? Травматология и ортопедия России. 2019;25(4):9-27. doi: 10.21823/2311-2905-2019-25-4-9-27.
  10. Kovochich M., Finley B.L., Novick R., Monnot A.D., Donovan E., Unice K.M. et al. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol. 2018;48(10):853-901. doi: 10.1080/10408444.2018.1563048.
  11. Postler A.E., Beyer F., Wegner T., Lützner J Hartmann A., Ojodu I., Günther K.P. Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty. Hip Int. 2017;27(2):180-186. doi: 10.5301/hipint.5000436.
  12. Toms A.D., Davidson D.C., Masri B.A., Duncan C.P. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg. 2006;88(2):149-155. doi: 10.1302/0301-620x.88b2.17058.
  13. Osmon D.R., Berbari E.F., Berendt A.R., Lew D., Zimmerli W., Steckelberg J.M. et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:1-10. doi: 10.1093/cid/cis966.
  14. Kurtz S.M., Lau E.C., Son M.S., Chang E.T., Zimmerli W., Parvizi J. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. J Arthroplasty. 2018;33(10):32383245. doi: 10.1016/j.arth.2018.05.042.
  15. Lee H.D., Prashant K., Shon W.Y.. Management of Periprosthetic Hip Joint Infection. Hip Pelvis. 2015;27(2):63-71. doi: 10.5371/hp.2015.27.2.63.
  16. Triantafyllopoulos G.K. , Soranoglou V.G. , Memtsoudis S.G. , Sculco T.P. , Poultsides L.A. Rate and Risk Factors for Periprosthetic Joint Infection Among 36,494 Primary Total Hip Arthroplasties. J Arthroplasty. 2018;33(4):1166-1170. doi: 10.1016/j.arth.2017.11.040.
  17. Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Тотоев З.А., Лю Б., Билык С.С. Структура ранних ревизий эндопротезирования тазобедренного сустава. Травматология и ортопедия России. 2014;(2):5-13. doi: 10.21823/2311-2905-2014-0-2-5-13.
  18. Pedersen A.B., Svendsson J.E., Johnsen S.P., Riis A., Overgaard S. Risk factors for revision due to infection after primary total hip arthroplasty. A population-based study of 80,756 primary procedures in the Danish Hip Arthroplasty Registry. Acta Orthop. 2010;81(5):542-547. doi: 10.3109/17453674.2010.519908.
  19. Cordero-Ampuero J., de Dios M. What Are the Risk Factors for Infection in Hemiarthroplasties and Total Hip Arthroplasties? Clin Orthop Relat Res. 2010;468(12): 3268-3277. doi: 10.1007/s11999-010-1411-8.
  20. Kurtz S.M., Ong K.L., Lau E., Bozic K.J., Berry D., Parvizi J. Prosthetic Joint Infection Risk after TKA in the Medicare Population. Clin Orthop Relat Res. 2010;468(1):52-56. doi: 10.1007/s11999-009-1013-5.
  21. Myers T.G., Mihalko W.M., Brown T.E., Saleh K.J., Cui Q. Outcomes of total hip arhtroplasty for osteonecrosis of the hip: systemic review and metaanalyses. Curr Orthop Pract. 2010;21(1):81-88. doi: 10.1097/BCO.0b013e3181b9b227.
  22. Alamanda V.K., Springer B.D. The prevention of infection: 12 modifiable risk factors. Bone Joint J. 2019;101-B(1_Supple_A):3-9. doi: 10.1302/0301-620X.101B1.BJJ-2018-0233.R1.
  23. Kunutsor S.K., Whitehouse M.R., Blom A Beswick A.D. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One. 2016;11(3):e0150866. doi: 10.1371/journal.pone.0150866.
  24. Hooper G.J., Rothwell A.G., Stringer M., Frampton C. Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry. J Bone Joint Surg Br. 2009;91(4):451-458. doi: 10.1302/0301-620X.91B4.21363.
  25. Jämsen E., Huhtala H., Puolakka T., Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91(1):38-47. doi: 10.2106/JBJS.G.01686.
  26. Havelin L.I., Fenstad A.M., Salomonsson R., Mehnert F., Furnes O., Overgaard S. et al. The Nordic Arthroplasty Register Association. A unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop. 2009;80(4):393-401. doi: 10.3109/17453670903039544.
  27. Taaffe K., Lee B., Ferrand Y., Fredendall L., San D., Salgado C. et al. The influence of traffic, area location, and other factors on operating room microbial load. Infect Control Hosp Epidemiol. 2018;39(4):391-397. doi: 10.1017/ice.2017.323.
  28. Weiser M.C., Shemesh S., Chen D.D., Bronson M.J., Moucha C.S. The effect of door opening on positive pressure and airflow in operating rooms. J Am Acad Orthop Surg. 2018;26(5):e105-e113. doi: 10.5435/JAAOS-D-16-00891.
  29. Fernández A.H., Monge V., Garcinuño M.A. Surgical antibiotic prophylaxis: effect in postoperative infections. Eur J Epidemiol. 2001;17(4):369-374. doi: 10.1023/A:101279433.
  30. Wilson D.G., Poole W.E., Chauhan S.K., Rogers B.A. Systematic review of aspirin for thromboprophylaxis in modern elective total hip and knee arthroplasty. Bone Joint J. 2016;98-B(8):1056-1061. doi: 10.1302/0301-620X.98B8.36957.
  31. George D.A., Drago L., Scarponi S., Gallazzi E Haddad F.S., Romano C.L. Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification. World J Orthop. 2017;8(5):400-411. doi: 10.5312/wjo.v8.i5.400.

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