Gabrielli Alexandra S, Wilson Alan E, Wawrose Richard A, Dombrowski Malcolm, O'Malley Michael J, Klatt Brian A
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, United States of America.
J Bone Jt Infect. 2022 Mar 22;7(2):55-60. doi: 10.5194/jbji-7-55-2022. eCollection 2022.
: Reinfection rates after two-stage exchange arthroplasty for prosthetic joint infection (PJI) have been reported as high as 33 % in the literature. Understanding risk factors for treatment failure will help to preoperatively counsel patients on the likelihood of successful treatment and possibly influence the surgeon's treatment algorithm. This study aimed to delineate whether the presence of a draining sinus tract is associated with risk of failure of two-stage exchange arthroplasty. : We performed a single institution, multi-center retrospective chart review of outcomes of patients treated for PJI with two-stage exchange arthroplasty between June 2006 and May 2016. For patients treated prior to 2011, PJI was defined based on the preoperative work-up and intraoperative findings as determined by the attending surgeon. After 2011, PJI was defined using MSIS consensus criteria. All patients had a minimum of follow-up of 2 years or treatment failure prior to 2 years. Treatment failure was defined as reinfection or failure to complete two-stage exchange secondary to persistent infection or other host factors. Operative reports and clinical notes were reviewed to assess for presence of a draining sinus tract. : 240 patients were treated for PJI with intended two-stage exchange arthroplasty. The overall rate of treatment failure was 29.6 % ( ), while the overall rate of reinfection was 13.3 % ( ). A total of 39 patients did not complete second stage revision; final treatment for these patients was amputation, fusion, or chronic antibiotic suppression. A total of 52 of 240 patients (21.7 %) had a draining sinus tract at presentation. Patients with a sinus tract were significantly likely to be replanted compared to those without a sinus tract at presentation (13.3 % vs. 26.9 %, ). However, when accounting for all mechanisms of treatment failure, including reinfection following replantation, there was no statistically significant difference detected between the sinus and no-sinus groups (27.7 % vs. 36.5 %, ). : A draining sinus tract represents a chronic, deep infectious process with ultimate compromise of overlying soft tissues. Thus we hypothesized it would be associated with failure in a two-stage exchange arthroplasty. These data demonstrate that patients with a draining sinus are significantly less likely to undergo re-implantation. This provides evidence to the paucity of data surrounding draining sinuses and two-stage PJI treatment.
人工关节感染（PJI）两阶段翻修置换术后的再感染率在文献中报道高达33%。了解治疗失败的风险因素将有助于术前向患者告知成功治疗的可能性，并可能影响外科医生的治疗方案。本研究旨在明确引流窦道的存在是否与两阶段翻修置换术失败的风险相关。
我们对2006年6月至2016年5月期间接受两阶段翻修置换术治疗PJI的患者进行了单机构、多中心回顾性病历审查。对于2011年之前接受治疗的患者，PJI根据主刀医生术前检查和术中发现进行定义。2011年之后，PJI根据MSIS共识标准进行定义。所有患者至少随访2年或在2年之前出现治疗失败。治疗失败定义为再感染或因持续感染或其他宿主因素未能完成两阶段翻修。审查手术报告和临床记录以评估引流窦道的存在情况。
240例患者接受了旨在进行两阶段翻修置换术的PJI治疗。总体治疗失败率为29.6%（ ），而再感染总体发生率为13.3%（ ）。共有39例患者未完成二期翻修；这些患者的最终治疗为截肢、融合或长期抗生素抑制。240例患者中有52例（21.7%）在就诊时有引流窦道。与就诊时无窦道的患者相比，有窦道的患者再次植入的可能性显著降低（13.3%对26.9%， ）。然而，在考虑所有治疗失败机制，包括再次植入后的再感染时，有窦道组和无窦道组之间未检测到统计学上的显著差异（27.7%对36.5%， ）。
引流窦道代表一种慢性、深部感染过程，最终会导致覆盖的软组织受损。因此，我们假设它与两阶段翻修置换术失败相关。这些数据表明，有引流窦道的患者再次植入的可能性显著降低。这为围绕引流窦道和两阶段PJI治疗的数据匮乏提供了证据。
