Davis Benjamin, Ford Amy, Holzmeister Adam M, Rees Harold W, Belich Paul D
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL.
Arthroplast Today. 2021 Mar 11;8:124-127. doi: 10.1016/j.artd.2021.02.012. eCollection 2021 Apr.
Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). A sinus tract communicating with a prosthetic joint is a major criterion defining PJI. Despite this fact, many patients presenting with a draining sinus tract undergo invasive procedures before initiation of two-stage revision arthroplasty. We hypothesized that many patients undergo nondefinitive procedures to treat the sinus tract, rather than undergoing definitive treatment of infection with two-stage revision.
A retrospective review of all cases of two-stage revision arthroplasty at Loyola University Medical Center between January 2004 and May 2018 was performed. Patients with infected TJA and periprosthetic sinus tract were included. Records were queried for laboratory values and prior procedures.
We identified 160 patients who underwent two-stage revision for infection over the 14-year period. Of the 160 patients, 25 had a documented periprosthetic sinus tract before initiation of definitive revision arthroplasty and were included. Eleven (44.0%) had one or more procedures including interventional radiology drain placement, local wound care, or formal irrigation and debridement before definitive treatment Forty-five percent of patients that underwent nondefinitive procedures before definitive surgery had either an erythrocyte sedimentation rate or C-reactive protein at normal or near-normal levels.
Many arthroplasty patients presenting with periprosthetic sinus tracts undergo nondefinitive procedures before definitive treatment. Inherent surgical risks of these procedures can increase the overall morbidity and mortality of these patients. Further effort is needed to educate surgeons regarding management of sinus tracts after TJA.
人工关节感染（PJI）是全关节置换术（TJA）后一种严重的并发症。与人工关节相通的窦道是定义PJI的主要标准。尽管如此，许多有引流窦道的患者在进行二期翻修置换术之前接受了侵入性操作。我们推测，许多患者接受了非确定性的窦道治疗程序，而不是接受二期翻修的感染确定性治疗。
对2004年1月至2018年5月在洛约拉大学医学中心进行的所有二期翻修置换术病例进行回顾性研究。纳入感染性TJA和假体周围窦道的患者。查询记录以获取实验室值和先前的操作。
我们确定了160例在14年期间因感染接受二期翻修的患者。在这160例患者中，25例在进行确定性翻修置换术之前有记录的假体周围窦道，并被纳入研究。11例（44.0%）在确定性治疗之前进行了一项或多项操作，包括介入放射学引流管置入、局部伤口护理或正式的冲洗和清创。在确定性手术前接受非确定性操作的患者中，45%的患者红细胞沉降率或C反应蛋白处于正常或接近正常水平。
许多有假体周围窦道的关节置换术患者在确定性治疗之前接受了非确定性操作。这些操作固有的手术风险会增加这些患者的总体发病率和死亡率。需要进一步努力对外科医生进行TJA后窦道管理方面的教育。
