Risk factors for periprosthetic joint infection after hip or knee arthroplasty in Mainland of China: a meta-analysis

doi:10.3969/j.issn.2095-4344.2017.35.025

Abstract

Abstract:

BACKGROUND: Periprosthetic joint infection (PJI) is a serious and catastrophic complication after hip or knee arthroplasty. With aging population increasing, more patients will undergo hip or knee arthroplasty. Studies have shown that the risk for PJI following arthroplasty is different in different populations.

OBJECTIVE: To evaluate the risk factors for PJI after hip or knee arthroplasty in Mainland of China through a meta-analysis, thereby providing reference for the prevention and control of postoperative PJI.

METHODS: A computer-based search of WanFang, CNKI, VIP, CBM, PubMed, Cochrane, Embase and Medline databases was performed and the literatures concerning the risk factors for PJI after hip or knee arthroplasty in Mainland of China published before September 2016 were collected by manual retrieval and retrospective approach. All the literatures were screened based on the inclusion and exclusion criteria, followed by data extraction and analyzed on Stata 12.0 software.

RESULTS AND CONLUSION: (1) Finally 14 literatures were included, including 417 patients with PJI. (2) The results of the meta-analysis showed that the risk factors for PJI after hip or knee arthroplasty including the complication of diabetic mellitus, long-term use of steroids, long operation time (> 90 minutes), age (> 65 years), and history of hip or knee surgery. (3) To conclude, PJI after hip or knee arthroplasty is related to multiple factors, so physicians should pay attention to these factors to reduce the incidence of PJI.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Infection, Risk Factors, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Tie Xiao-jia, Zhao Meng, Han Ya-jun, Zhang Jing, Zhao He-yi, Ma Guo-ju. Risk factors for periprosthetic joint infection after hip or knee arthroplasty in Mainland of China: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5727-5732.

Figures/Tables 2

2.1 文献检索结果英文数据库检索到368篇文献，经筛选后纳入1篇；中文数据库检索到1 862篇文献，经筛选后纳入13篇。14篇文献涉及假体周围感染病例417例。文献筛选流程图见图1，文献基本特征见表1。 2.2 相关危险因素的Meta分析分析发现合并糖尿病、激素使用史、手术持续时间大于90 min、年龄大于65岁、既往膝髋关节手术史是髋膝关节置换术后假体周围感染的危险因素。 2.2.1 糖尿病对髋膝关节置换术后假体周围感染的影响本研究共有9篇文献涉及糖尿病对髋膝关节置换术后假体周围感染的影响[5，7-8，10-15，19]，研究显示9篇文献存在统计学异质性(P=0.001，I2=68.6%)，故采用随机效应模型，结果显示OR=3.47，95%CI：2.29-5.42，即糖尿病是髋膝关节置换术后假体周围感染的危险因素，见图2。 2.2.2 激素使用史对髋膝关节置换术后假体周围感染的影响本研究共有5篇文献涉及激素使用史对髋膝关节置换术后假体周围感染的影响[7，11-13，18]，研究显示5篇文献存在统计学异质性(P < 0.001，I2=93.0%)，故采用随机效应模型，结果显示OR=3.12，95%CI：1.37-7.10，即激素使用史是髋膝关节置换术后假体周围感染的危险因素，见图3。 2.2.3 手术持续时间大于90 min对髋膝关节置换术后假体周围感染的影响本研究共有3篇文献涉及手术持续时间大于90 min对髋膝关节置换术后假体周围感染的影响[9，11，17]，研究显示3篇文献无统计学异质性(P=0.317，I2=13.0%)，故采用固定效应模型，结果显示OR=2.62，95%CI：1.73-3.97，即手术持续时间大于90 min是髋膝关节置换术后假体周围感染的危险因素，见图4。 2.2.4 年龄大于65岁对髋膝关节置换术后假体周围感染的影响本研究共有3篇文献涉及年龄大于65岁对髋膝关节置换术后假体周围感染的影响[10，16，19]，研究显示3篇文献存在统计学异质性(P=0.027，I2=72.5%)，故采用随机效应模型，结果显示OR=1.97，95%CI：0.27-14.42，即年龄大于65岁是髋膝关节置换术后假体周围感染的危险因素，见图5。 2.2.5 既往髋膝关节手术史对髋膝关节置换术后假体周围感染的影响本研究共有4篇文献涉及既往髋膝关节手术史对髋膝关节置换术后假体周围感染的影响[10，12-14]，研究显示4篇文献存在统计学异质性(P < 0.001，I2=93.4%)，故采用随机效应模型，结果显示OR=2.85，95%CI：1.41-5.78，即既往髋膝关节手术史是髋膝关节置换术后假体周围感染的危险因素，见图6。 "

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