Budin Maximilian, Luo T David, Lausmann Christian, Gehrke Thorsten, Citak Mustafa
Department of Orthopaedic Surgery, HELIOS ENDO-Clinic Hamburg, Holstenstraße 2, 22767, Hamburg, Germany.
Arch Orthop Trauma Surg. 2024 Dec 21;145(1):84. doi: 10.1007/s00402-024-05713-8.
A sinus tract, an abnormal channel between the skin and joint, is a major criterion that proves the presence of an underlying periprosthetic joint infection. Its presence not only increases failure rates but also leads to poor outcomes. Despite its clinical relevance, little is known about risk factors and underlying microorganism profiles. The aim of this study was to investigate PJIs of the hip with a sinus tract, identifying risk factors and microorganism profiles.
This was a retrospective case control study of all PJI cases of the hip treated at our institution. A total of 4,368 cases with a PJI of the hip were identified of which 653 patients (14.95%), displayed a sinus tract. Univariate and multivariate analysis was performed. Odds ratio (OR) and 95% confidence interval (CI) were presented.
Multivariate analysis identified diabetes mellitus (p = 0.004; OR = 1.62; 95% CI 1.17-2.44), history of ileus (p < 0.001; OR = 4.65; 95% CI 2.38-9.08), osteomyelitis (p < 0.001; OR = 2.35; 95% CI 1.65-3.35) and prior revisions (p = 0-014; OR = 1.36; 95% CI 1.07-1.74) as risk factors for a sinus tract. Polymicrobial infections (p < 0.001; OR = 2.35; 95% CI 1.86-2.96), Staphylococcus aureus (p < 0.001; OR = 3.67; 95% CI 2.86-4.71) and Escherichia coli (p = 0.014; OR = 1.65; 95% CI 1.11-2.46) were associated with a sinus tract in PJIs of the hip.
Microorganism profiles and risk factors differ significantly in patients with PJI of a THA with a sinus tract. These insights can help surgeons in planning and selecting appropriate antibiotics for cement loading and empiric antibiotic treatment, as well as in risk stratification of patients, who may develop a sinus tract following THA.
窦道是皮肤与关节之间的异常通道，是证明存在假体周围关节感染的主要标准。它的存在不仅会增加失败率，还会导致预后不良。尽管其具有临床相关性，但对危险因素和潜在微生物谱却知之甚少。本研究的目的是调查伴有窦道的髋关节假体周围感染（PJI），确定危险因素和微生物谱。
这是一项对在我们机构接受治疗的所有髋关节PJI病例进行的回顾性病例对照研究。共确定了4368例髋关节PJI病例，其中653例患者（14.95%）有窦道。进行了单因素和多因素分析。给出了比值比（OR）和95%置信区间（CI）。
多因素分析确定糖尿病（p = 0.004；OR = 1.62；95% CI 1.17 - 2.44）、肠梗阻病史（p < 0.001；OR = 4.65；95% CI 2.38 - 9.08）、骨髓炎（p < 0.001；OR = 2.35；95% CI 1.65 - 3.35）和既往翻修手术（p = 0.014；OR = 1.36；95% CI 1.07 - 1.74）为窦道的危险因素。多种微生物感染（p < 0.001；OR = 2.35；95% CI 1.86 - 2.96）、金黄色葡萄球菌（p < 0.001；OR = 3.67；95% CI 2.86 - 4.71）和大肠杆菌（p = 0.014；OR = 1.65；95% CI 1.11 - 2.46）与髋关节PJI中的窦道有关。
伴有窦道的全髋关节置换术（THA）的PJI患者的微生物谱和危险因素有显著差异。这些见解有助于外科医生规划和选择合适的抗生素进行骨水泥加载及经验性抗生素治疗，以及对THA后可能出现窦道的患者进行风险分层。
