假体周围感染

BIOLOX®陶瓷降低感染风险2

“假体周围感染是关节置换中严重的并发症之一…假体周围感染的发生率呈现上升趋势, 在美国预计于2023年将有超过60000到70000例髋膝假体周围感染病例”。5

就关节置换整体来看,假体周围感染发生率1%,但这是最常导致假体失败。PJI是膝关节翻修最常见的指征,而在髋关节翻修中PJI是位于第三位的指征(所有髋关节翻修中占15.6%)4。在美国预计于2020年,每年用于感染翻修的花费将超过 16.2亿美元3

Revision Reasons THA

图表1: THA的翻修原因

Revision reasons TKA

图表2: THA的翻修原因

Revision reasons for Shoulder Arthroplasty

图表3: 肩关节置换的翻修原因

理论上导致感染是多因素作用的结果,但关节面对感染的发生有着显著影响(图表4)。

实验研究结果已经提示陶瓷材料优于其他材料表现出最低的感染率1。这些研究比较了陶瓷、金属和聚乙烯。基于500749例髋关节翻修的数据分析,证实了陶瓷材料在体内降低感染发生的潜力2

研究数据分析基于多家医院和登记中心的数据采用Cox模型分析协同因素,结果提示与陶对陶和陶对聚乙烯相比,金属部件更易于发生感染(陶瓷关节面比金属低30-50%);陶瓷关节在关节面无金属离子的释放,而在锥连接部金属离子释放也是极少的。8

图表4: 感染翻修(500749名患者)

Revisions for Infection (500’749 pats)

图表5: 感染导致的翻修率:
金属对聚乙烯感染风险比陶瓷对聚乙烯高2.6倍。

参考文献

  1. Liefheit K, Vergleichende Biofilmbildung auf Werkstoffe, Bericht, iba Heiligenstadt e.V. FB Biowerkstoffe, 2013
  2. Streicher R, Porporati A. News on ceramics – beyond wear reduction. Abstract EHS 2014, Streicher R, Leto A, Porporati A - News on ceramic – wear, corrosion and infection. Poster JHS 2014
  3. Kurtz SM1, Lau E, Watson H, Schmier JK, Parvizi J., Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep;27(8 Suppl):61-5.e1. doi: 10.1016/j.arth.2012.02.022. Epub 2012 May 2.
  4. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty 2009; 24:105-109.
  5. A Recurring Slippery Slope, Javad Parvizi, M.D., F.R.C.S., CURRENT CONCEPTS IN JOINT REPLACEMENT® Winter 2014 Hyatt Regency Grand Cypress, Orlando, Florida, December 10 - 13, 2014
  6. Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468:52-56.
  7. Calus Varnium, Alam B Pedersen, Per Kjaersgaard/Andersen, and Soren Overgaard. Comparison of the risk of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings. Acta Orthopaedica 2015;86 (3):x-x
  8. Smith L, Alijanipour P, Restrepo C, Maltenfort M, Parvizi J, Malkani A. Periprosthetic joint infection: could the bearing surface play a role? Abstract, Meeting of the Eastern Orthopaedic Association 2014
  9. S. Falcioni, C. Ancarani, B. Bordini, M.S. Pichierri, S. Stea Influence of articular coupling on septic loosening of total hip arthroplasty, 11th EHS Congress, Stockholm - Sweden, 9-11 October 2014 Hip Int 2014; 24 (5): 491
  10. National Joint Registry for England, Wales and Northern Ireland - 10th Annual Report 2013
  11. Rihard Trebše, Vesna Levašič , Simon Kovac Prosthetic Joint Infections and Bearings Abstracts from 11th EHS Congress, Stockholm - Sweden, 9-11 October 2014 Hip Int 2014; 24 (5): 491
  12. C. Varnum, A. b. pedersen, P. Kjaersgaard-Andersen and S. Overgaard, Comparison of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings- Data on 11096 patients from the Danish Hip Arthroplasty registry, Acta Orthpaedcia 2015, 86: x-x (doi:10.3109/17453674.2015.1012975)
  13. Kevin J. Bozic MD, MBA, Kevin Ong PhD, Edmund Lau MS, Steven M. Kurtz PhD, Thomas P. Vail MD, Harry E. Rubash MD, Daniel J. Berry MD Risk of Complication and Revision Total Hip Arthroplasty Among Medicare Patients with Different Bearing Surfaces Clinical Orthopaedics and Related Research® September 2010, Volume 468, Issue 9, pp 2357-2362
  14. Parvizi J. Periprosthetic joint infection: could the bearing surface play a role? CeraNews 1/2014, 11

参考文献

CeraNews 2014-02 12–22页

CeraNews 2014-01 12–22页

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