| BackgroundTotal knee arthroplasty(TKA)is a safe and effective method for the treatment of osteoarthritis and other knee diseases.It has been proved to be relatively successful in improving the quality of life and reducing pain of patients with severe knee diseases.Although it is widely reported that the operation is relatively mature,periprosthetic joint infection(PJI),as a rare complication,is recognized as the most serious and terrible complication after TKA,which often causes disastrous consequences and is also a great challenge for orthopaedic surgeons.Studies have shown that the incidence of PJI is as high as 2% in TKA cases.And with an aging and growing obese population,the volume of TKA surgery increases,which means that the incidence of PJI increases.Malnutrition is a common and variable factor for postoperative complications and poor prognosis in orthopedics,and previous studies have shown that the association between nutritional status and the incidence of postoperative complications is strong.The purpose of this study was to evaluate and analyze the correlation between biological indicators of malnutrition and the incidence of postoperative PJI in patients undergoing elective total knee arthroplasty in order to identify potential risk factors for the development of PJI after TKA.ObjectiveCollect data,identify the potential risk factors of periprosthetic infection after initial total knee arthroplasty through software processing,and reduce the incidence of PJI by optimizing and changing risk factors.MethodsA systematic retrospective review of patients who underwent primary TKA between January 2016 and October 2019 in a hospital in Henan Province included 868 patients who were matched for age,gender,smoking history,alcohol consumption history,body mass index(BMI),preoperative nutritional assessment including: serum albumin(Alb),hemoglobin(Hb),Total Lymphocyte Count(TLC)and Total Cholesterol(TC)levels,among others,including BMI groupings.Thirty-six patients were included in the diagnostic criteria for PJI after surgery,previous comorbid underlying disease conditions: Only common histories of hypertension and diabetes were collected.Biological indicators of nutritional status were evaluated by logistic regression analysis and correlation studies with PJI in order to identify risk factors for PJI.ResultsA total of 36 PJI occurred in 868 patients.The preoperative nutritional indicators of patients were statistically analyzed,and the incidence of low Alb,low Hb,low TLC,low TC,high TC,overweight and obesity groups were 8.8%,14.3%,19.0%,20.0%,38.0%,42.1% and 38.6%,respectively.Chi square and logistic regression analyses were performed on the following variables,one-way regression analysis revealed that low Alb(OR=0.145,95% CI 0.070～0.300,P=0.007),anemia(OR=0.239,95% CI0.119～0.482,P=0.010),low TLC(OR=0.348,95% CI 0.174-0.697,P=0.003),low TC(OR=0.438,95% CI0.202-0.950,P=0.037)and obesity(OR=0.242,95% CI 0.103-0.568,P=0.006)were potential risk factors for the development of PJI after TKA;Multifactorial regression analysis showed that low Alb(OR=0.224,95%CI 0.091～0.552,P=0.001),anemia(OR=0.263,95%CI 0.104～0.670,P=0.005),low TLC(OR=0.331,95%CI 0.153～0.717,P=0.005),low TC(OR=0.291,95% CI 0.121 to 0.700,P=0.006)and obesity(OR=0.198,95% CI 0.080 to 0.491,P=0.001)were risk factors for PJI after TKA.In contrast,high TC and overweight were not significantly associated with the incidence of PJI.ConclusionLow Alb,anemia,low TLC,low TC,and obesity were significantly associated with increased risk of PJI and were risk factors for the development of PJI after TKA,whereas high TC and overweight were not significantly associated with increased risk of PJI. |
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