Bacteriology and risk factors associated with periprosthetic joint infection after primary total knee arthroplasty: retrospective study of 2543 cases

Abstract

Introduction: Periprosthetic joint infection after total knee arthroplasty is a serious complication. This study aimed to identify risk factors and bacteriological features associated with periprosthetic joint infection after primary total knee arthroplasty performed at a teaching hospital.

Methods: We reviewed 2543 elective primary total knee arthroplasties performed at our institution from 1993 to 2013. Data were collected from the Hong Kong Hospital Authority’s Clinical Data Analysis and Reporting System, the Infection Control Team, and the joint replacement division registry. The association between potential risk factors and periprosthetic joint infection was examined by univariable analysis and multivariable logistic regression. Univariable analyses were also performed to examine the association between potential risk factors and bacteriology and between potential risk factors, including bacteriology, and early-onset infection.

Results: The incidence of periprosthetic joint infection in our series was 1.34% (n=34). The incidence of early-onset infection was 0.39% (n=24). Of the periprosthetic joint infections, 29.4% were early-onset infections. In both univariable and multivariable analyses, only rheumatoid arthritis was a significant predictor of periprosthetic joint infection. Methicillin-sensitive Staphylococcus aureus was the most common causative organism. We did not identify any significant association between potential risk factors and bacteriology. Periprosthetic joint infection caused by skin flora was positively associated with early-onset infection but the association was not statistically significant.

Conclusion: The incidence of periprosthetic joint infection after elective primary total knee arthroplasty performed at our institution from 1993 to 2013 was 1.34%. Rheumatoid arthritis was a significant risk factor for periprosthetic joint infection.

引言：全膝關節置換術後人工關節周邊關節感染是一種嚴重併發症。本研究旨在確定一所教學醫院進行初次全膝關節置換術後人工關節周邊關節的風險因素和細菌學特徵。 方法：我們回顧1993年至2013年期間在本院進行的2543例常規初次全膝關節置換術。數據來自醫院管理局臨床數據分析和報告系統、感染控制小組以及關節置換部門資料統計中心。通過單變量分析和多變量邏輯迴歸，找出潛在危險因素與人工關節周邊關節感染之間的相關性。單變量分析亦被用作檢視潛在風險因素與細菌學之間以及潛在風險因素（包括細菌學）與早發性感染之間的相關性。 結果：人工關節周邊關節感染的現患率為1.34%（34例）。早發感染的現患率為0.39%（24例）。在人工關節周邊關節感染的病例中，29.4%為早發性感染。在單變量和多變量分析中，只有類風濕關節炎是人工關節周邊關節感染的重要預測因子。對甲氧西林具耐藥性的金黃色葡萄球菌是最常見致病微生物。潛在危險因素與細菌學之間沒有顯著相關性。由皮膚菌群引起的人工關節周邊關節感染與早發性感染呈正相關但在統計學上並不顯著。 結論：1993年至2013年期間在本院進行常規全膝關節置換術後，人工關節周邊關節感染的現患率為1.34%。類風濕關節炎是人工關節周邊關節感染的重要危險因素。