The Presence of Sinus Tract Adversely Affects the Outcome of Treatment of Periprosthetic Joint Infections |
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Authors: | Chi Xu Qiaojie Wang Feng-Chih Kuo Karan Goswami Timothy L Tan Javad Parvizi |
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Institution: | 1. The Rothman Institute at Thomas Jefferson University, Philadelphia, PA;2. Department of Orthopaedic Surgery, General Hospital of People''s Liberation Army, Beijing, China;3. Department of Orthopaedic Surgery, Shanghai Sixth People''s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China;4. Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;5. College of Medicine, Chang Gung University, Kaohsiung, Taiwan |
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Abstract: | BackgroundA sinus tract may be encountered in patients with periprosthetic joint infection (PJI) and constitutes a major criterion for diagnosis. The aim of this study is to identify associated factors for the presence of sinus tract and outcome of 2-stage exchange arthroplasty in these patients.MethodsWe retrospectively reviewed all patients with PJI following hip and knee arthroplasty from 2000 to 2017. Of them, 161 patients with a sinus tract had a minimum follow-up of 1 year following 2-stage exchange arthroplasty. These patients were matched 1:2 with those without sinus tract by using propensity score matching. Treatment success was assessed using the modified Delphi criteria. A multiple logistic regression analysis was performed to determine the effect of sinus tract on the outcome and associated factors for the presence of sinus tract.ResultsFactors significantly associated with sinus tract included smoking (odds ratio OR] = 1.83), hypothyroidism (OR = 1.62), hypoalbuminemia (OR = 1.52), hip joint involvement (OR = 1.43), and prior revision surgery (OR = 1.37). Patients with sinus tract had a significantly higher rate of failure compared to those without sinus tract (OR = 2.94).ConclusionThis study demonstrates that the presence of sinus tract in patients with PJI adversely affects the outcome of treatment of these patients. The presence of sinus tract may be a proxy for other issues such as poor periarticular soft tissue, the poor nutritional status of the host, and multiple prior operations. These findings need to be borne in mind when treating patients with PJI and a concomitant sinus tract. |
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Keywords: | Reprint requests: Javad Parvizi MD FRCS The Rothman Institute at Thomas Jefferson University 125 S 9th St Ste 1000 Philadelphia PA 19107 sinus tract periprosthetic joint infection 2-stage exchange arthroplasty Hip Knee Outcomes |
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