Persistent Fistula for Treatment of a Failed Periprosthetic Joint Infection: Relic From the Past or a Viable Salvage Procedure? |
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| Institution: | 1. Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY;2. Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA;3. Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC;4. Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA;1. Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, NC;2. Department of Orthopaedics, Medical University of South Carolina, Charleston, SC;3. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH;4. Department of Orthopaedics, Harvard-Beth Israel Deaconess Medical Center, Boston, MA;1. Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Putz City, Chiayi, Taiwan;2. Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan;3. School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;4. Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Putz City, Chiayi, Taiwan;1. Department of Orthopaedic Surgery, CHU de Québec – Centre Hospitalier de l’Université Laval (CHUL), Québec City, Québec, Canada;2. Department of Orthopaedic Surgery, Hôtel-Dieu-de-Lévis, Lévis, Québec, Canada;3. Department of Surgery, Faculté de Médecine, Université Laval, Québec City, Québec, Canada;4. Department of Orthopaedic Surgery, CHU de Québec – Hôtel-Dieu-de-Québec, Québec, Québec, Canada |
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| Abstract: | BackgroundNew treatment algorithms for periprosthetic joint infections (PJIs) show high success rates in achieving permanent infection eradication with some degree of failure. Different salvage procedures are described, but there is no evidence for persistent fistula (PF). The purpose of this study was to analyze PF as a salvage procedure in patients with therapy-resistant PJIs.MethodsThis retrospective analysis included all patients treated with PF (2005-2018) in a maximum care center with PJI (knee or hip). The baseline parameters (age, sex, BMI) and other data (number of surgeries, pathogen spectrum, American Society of Anesthesiologists classification) were recorded. The function was documented using the Harris Hip Score, the Knee Society Score, and the quality of life using the SF-36 Health Survey.ResultsA total of 159 patients were included (80 ± 12 years) and subdivided into four groups: hip (n = 66), knee (n = 13), Girdlestone resection arthroplasty (n = 50), knee arthrodesis (n = 27). Patients stayed 111 ± 87 days in the hospital, underwent six operations and three revisions after establishing PF. The mean American Society of Anesthesiologists score was 2.7. The BMI was 31 ± 3 kg/m2 (P = .1). The follow-up was 2.8 ± 0.5 years including 27 patients. The Harris Hip Score and Knee Society Score were 38 and 34, respectively. SF-36 showed no significant difference.ConclusionThe study showed poor outcomes regarding quality of life and the function of the infected joint. Therefore, the indication for establishing a PF in the treatment of PJI must be assessed very critically. PF is only an option for multimorbid patients with a limited life expectancy. |
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| Keywords: | periprosthetic joint infection persistent fistula salvage procedure quality of life revision arthroplasty |
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