Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
BMC Musculoskelet Disord. 2024 Sep 7;25(1):721. doi: 10.1186/s12891-024-07840-0.
Reinfection rates after two-stage revision (TSR) for prosthetic joint infection (PJI) range from 7.9 to 14%. Many factors, including sinus tracts, are associated with reinfection after this procedure. This study aimed to delineate whether the presence of sinus tract could increase reinfection rate after TSR and to investigate other potential risk factors for reinfection after TSR.
We conducted a case-control study by retrospectively reviewing patients who underwent TSR for prosthetic hip joint infection from 2002 to 2022. The case group included patients who developed reinfection after TSR, while the control group consisted of patients who did not experience reinfection. PJI and reinfection after TSR were defined based on Delphi-based international consensus criteria. Patient demographics, past medical history, clinical manifestations, laboratory results, interval between stages, microbiological culture results were collected. Univariate analyses were utilized to assess the effect of sinus tract on reinfection and to identify other risk factors for reinfection after TSR.
Six patients with reinfection after TSR were included as the case group and 32 patients without reinfection were in the control group. Significant difference was observed in percentage of patients with sinus tracts between the two groups (67% in the case group versus 19% in the control group, p = 0.031, OR = 8.7). Significant difference was also found in percentage of patients with positive cultures of synovial fluid and synovium harvested during the first-stage revision between the two groups (100% in the case group versus 50% in the control group, p = 0.030). Additionally, patients in the case group had a significantly higher C-reactive protein (CRP) level prior to the second stage revision than that of patients in the control group (8.80 mg/L versus 2.36 mg/L, p = 0.005), despite normal CRP levels in all patients.
Our study revealed that the presence of sinus tracts could significantly increase risk of postoperative reinfection after TSR. Positive cultures during the first stage revision and elevated CRP level prior to the second stage revision could also increase the risk of reinfection after TSR. Further studies with a larger sample size are required.
Retrospectively registered.
假体关节感染（PJI）行两阶段翻修（TSR）后再感染率为 7.9%至 14%。许多因素，包括窦道，与该手术后再感染有关。本研究旨在探讨窦道的存在是否会增加 TSR 后再感染的风险，并研究 TSR 后再感染的其他潜在危险因素。
我们通过回顾性研究 2002 年至 2022 年期间因假体髋关节感染行 TSR 的患者，进行了病例对照研究。病例组包括 TSR 后发生再感染的患者，对照组为未发生再感染的患者。PJI 和 TSR 后再感染的定义基于基于德尔菲共识的国际标准。收集了患者的人口统计学资料、既往病史、临床表现、实验室结果、阶段间隔、微生物培养结果。采用单因素分析评估窦道对再感染的影响，并确定 TSR 后再感染的其他危险因素。
6 例 TSR 后再感染的患者被纳入病例组，32 例无再感染的患者纳入对照组。两组间窦道患者比例有显著差异（病例组 67%，对照组 19%，p=0.031，OR=8.7）。两组间初次翻修时关节液和滑膜培养阳性的患者比例也有显著差异（病例组 100%，对照组 50%，p=0.030）。此外，病例组患者在进行第二期翻修前的 C 反应蛋白（CRP）水平显著高于对照组（8.80mg/L 比 2.36mg/L，p=0.005），尽管所有患者的 CRP 水平均正常。
本研究表明，窦道的存在显著增加了 TSR 后术后再感染的风险。初次翻修时的培养阳性和第二期翻修前 CRP 水平升高也可能增加 TSR 后再感染的风险。需要进一步开展更大样本量的研究。
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