Periprosthetic Joint Infection after Primary Total Knee Arthroplasty With and Without Sinus Tract: Treatment Outcomes

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Abstract

Background. Sinus tract appears up to 20% of patients with periprosthetic joint infection (PJI) after primary total joint arthroplasty (TJA). The adverse effect of different patient related risk factors is well known, but the role of the sinus tract in PJI recurrence wasn’t properly investigated. The purpose of the study was to analyze the influence of a sinus tract on the effectiveness of two-stage reimplantation in PJI. Material and Methods. In order to reduce the influence of known risk factors on effectiveness of infection eradication several including criteria were introduced: patients with PJI after primary total knee arthroplasty (TKA), without surgeries before TKA and after infection manifestation and without attempts of antibiotic suppression. Finally, 119 of 475 patients with PJI after primary TKA, treated with two-stage protocol, were retrospectively analyzed: 33 patients with presence of the sinus tract, 86 — without sinus tract. Pathogen type, comorbidities, PJI type, bone defects, duration of surgery, intraoperative blood loss and the effectiveness of twostage reimplantation were analyzed. Results. Pathogen structure in analyzed groups was comparable. Staphylococci were the leading cause of PJI in compared groups: 64.4% of patients without sinus tract and 59.1% of patients with sinus tract. Wherein S. aureus was more frequently isolated in case of active sinus tract while S. epidermidis played the leading role in compared group. Polymicrobial PJI was more likely to develop in patients with sinus tract (p = 0.09). Massive bone defects of femur and tibia (type 3 according AORI classification) were identified only in patients with sinus tract PJI, as well as significantly longer duration of the spacer implantation and higher intraoperative blood loss at this stage (p<0.05). Infection eradication after spacer implantation stage was achieved in 98.8% (n = 79) of patients without sinus tract while only 81% (n = 17) of patients with sinus tract PJI successfully passed this stage of surgical treatment (p<0.05), effectiveness of revision knee arthroplasty was 98.7% (n = 78) and 76.5% (n = 13) respectively (p<0.05). Finally, complex effectiveness of twostage reimplantation in patients with sinus tract was significantly lower (61.9%) than in patients of compared group (97.5%), p<0.05. Conclusion. Presence of the sinus tract in patients with PJI after primary TKA adversely effects on the effectiveness of two-stage reimplantation, this fact could be explained by aggressive development of infection, caused by more virulent pathogens and higher frequency of polymicrobial cases among this cohort of patients. The established patterns require further research to develop tactics for managing this category of patients in order to increase the effectiveness of two-stage reimplantation.

About the authors

P. M. Preobrazhensky

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: Pedrro@yandex.ru
ORCID iD: 0000-0002-9569-1566

Petr M. Preobrazhensky — Cand. Sci. (Med.), Researcher

St. Petersburg

Russian Federation

S. A. Bozhkova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: clinpharm-rniito@yandex.ru
ORCID iD: 0000-0002-2083-2424

Svetlana A. Bozhkova — Dr. Sci. (Med.), Head of the Scientific Department of Prevention and Treatment of Wound Infection

St. Petersburg

Russian Federation

A. N. Panteleev

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: Alex.pant95@mail.ru
ORCID iD: 0000-0001-9925-0365

Alexander N. Panteleev — PhD Student

St. Petersburg

Russian Federation

R. M. Tikhilov

Vreden National Medical Research Center of Traumatology and Orthopedics; Mechnikov North-Western State Medical University

Email: rtikhilov@gmail.com
ORCID iD: 0000-0003-0733-2414

Rashid M. Tikhilov — Dr. Sci. (Med.), Professor, Director, Vreden Russian Research Institute for Traumotology and Orthopaedics; Professor, Traumatology and Orthopedics Department, Mechnikov North-Western State Medical University

St. Petersburg

Russian Federation

A. V. Kazemirsky

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: Alexkazemir@mail.ru
ORCID iD: 0000-0002-5652-6541

Alexander V. Kazemirsky — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

References

  1. Lewis P.L., Graves S.E., Robertsson O., Sundberg M., Paxton E.W., Prentice H.A., W-Dahl A. Increases in the rates of primary and revision knee replacement are reducing: a 15-year registry study across 3 continents. Acta Orthop. 2020;91(4):414-419. doi: 10.1080/17453674.2020.1749380.
  2. Drago L., De Vecchi E., Bortolin M., Zagra L., Romanò C.L., Cappelletti L. Epidemiology and Antibiotic Resistance of Late Prosthetic Knee and Hip Infections. J Arthroplasty. 2017;32(8):2496-2500. doi: 10.1016/j.arth.2017.03.005.
  3. Otto-Lambertz C., Yagdiran A., Wallscheid F., Eysel P., Jung N. Periprosthetic Infection in Joint Replacement. Dtsch Arztebl Int. 2017;114(20):347-353. doi: 10.3238/arztebl.2017.0347.
  4. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2019 Annual Report. Adelaide: AOA, 2018. Available from: https://aoanjrr.sahmri.com/documents/10180/576950/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty
  5. Kurtz S.M., Lau E.C., Son M.S., Chang E.T., Zimmerli W., Parvizi J. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. J Arthroplasty. 2018;33(10):32383245. doi: 10.1016/j.arth.2018.05.042.
  6. Zmistowski B., Karam J.A., Durinka J.B., Casper D.S., Parvizi J. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am. 2013;95(24):2177-2184. doi: 10.2106/JBJS.L.00789.
  7. Xu C., Wang Q., Kuo F.C., Goswami K., Tan T.L., Parvizi J. The Presence of Sinus Tract Adversely Affects the Outcome of Treatment of Periprosthetic Joint Infections. J Arthroplasty. 2019;34(6):1227-1232. doi: 10.1016/j.arth.2019.02.040
  8. Parvizi J., Gehrke T., Chen A.F. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450-1452. doi: 10.1302/0301-620X.95B11.33135.
  9. Parvizi J., Tan T.L., Goswami K., Higuera C., Della Valle C., Chen A.F., Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018;33(5):1309-1314. doi: 10.1016/j.arth.2018.02.078.
  10. Crowe B., Payne A., Evangelista P.J., Stachel A., Phillips M.S., Slover J.D. et al. Risk Factors for Infection Following Total Knee Arthroplasty: A Series of 3836 Cases from One Institution. J Arthroplasty. 2015;30(12):22752278. doi: 10.1016/j.arth.2015.06.058.
  11. Namba R.S., Inacio M.C., Paxton E.W. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013;95(9):775-782. doi: 10.2106/JBJS.L.00211.
  12. Tayton E.R., Frampton C., Hooper G.J., Young S.W. The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty: an analysis of 64,566 joints from the New Zealand Joint Registry. Bone Joint J. 2016;98-B(3):334-340. doi: 10.1302/0301-620X.98B3.36775.
  13. Zimmerli W., Trampuz A., Ochsner P.E. Prostheticjoint infections. N Engl J Med. 2004;351(16):1645-1654. doi: 10.1056/NEJMra040181.
  14. Engh G.A., Ammeen D.J. Classification and preoperative radiographic evaluation: knee. Orthop Clin North Am. 1998;29(2):205-217. doi: 10.1016/s0030-5898(05)70319-9.
  15. Hofmann A.A., Kane K.R., Tkach T.K., Plaster R.L., Camargo M.P. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop Relat Res. 1995;(321):45-54.
  16. Bozic K.J., Lau E., Kurtz S., Ong K., Rubash H., Vail T.P., Berry D.J. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am. 2012;94(9):794-800. doi: 10.2106/JBJS.K.00072.
  17. Greenky M., Gandhi K., Pulido L., Restrepo C., Parvizi J. Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection? Clin Orthop Relat Res. 2012;470(10):2695-2701. doi: 10.1007/s11999-012-2435-z.
  18. Kunutsor S.K., Whitehouse M.R., Blom A.W., Beswick A.D. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and MetaAnalysis. PLoS One. 2016;11(3):e0150866. doi: 10.1371/journal.pone.0150866.
  19. Сараев А.В., Линдберг М.Ф., Гэй К., Росселэнд Л.А., Лердал А., Корнилов Н.Н., Куляба Т.А. Факторы, влияющие на интенсивность болевого синдрома в раннем послеоперационном периоде после тотальной артропластике коленного сустава. Травматология и ортопедия России. 2017;23(1):45-58. doi: 10.21823/2311-2905-2017-23-1-45-58.
  20. Божкова С.А., Касимова А.Р., Тихилов Р.М., Полякова Е.М., Рукина А.Н., Шабанова В.В., Ливенцов В.Н. Неблагоприятные тенденции в этиологии ортопедической инфекции: результаты 6-летнего мониторинга структуры и резистентности ведущих возбудителей. Травматология и ортопедия России. 2018;24(4):20-31. doi: 10.21823/2311-2905-2018-24-4-20-31.
  21. Triffault-Fillit C., Ferry T., Laurent F., Pradat P., Dupieux C., Conrad A. et al. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study. Clin Microbiol Infect. 2019;25(3):353-358. doi: 10.1016/j.cmi.2018.04.035.
  22. Richardson A.R. Virulence and Metabolism. Microbiol Spectr. 2019;7(2). doi: 10.1128/microbiolspec.GPP3-0011-2018.
  23. Wimmer M.D., Friedrich M.J., Randau T.M., Ploeger M.M., Schmolders J., Strauss A.A. et al. Polymicrobial infections reduce the cure rate in prosthetic joint infections: outcome analysis with twostage exchange and follow-up ≥two years. Int Orthop. 2016;40(7):1367-1373. doi: 10.1007/s00264-015-2871-y.
  24. Tan T.L., Kheir M.M., Tan D.D., Parvizi J. Polymicrobial Periprosthetic Joint Infections: Outcome of Treatment and Identification of Risk Factors. J Bone Joint Surg Am. 2016;98(24):2082-2088. doi: 10.2106/JBJS.15.01450.
  25. Haddad F.S., Sukeik M., Alazzawi S. Is singlestage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res. 2015;473(1):8-14. doi: 10.1007/s11999-014-3721-8.
  26. Zahar A., Kendoff D.O., Klatte T.O., Gehrke T.A. Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results. Clin Orthop Relat Res. 2016;474(1):81-87. doi: 10.1007/s11999-015-4408-5.
  27. Jenny J.Y., Lengert R., Diesinger Y., Gaudias J., Boeri C., Kempf J.F. Routine one-stage exchange for chronic infection after total hip replacement. Int Orthop. 2014;38(12):2477-2481. doi: 10.1007/s00264-014-2466-z.
  28. Srivastava K., Bozic K.J., Silverton C., Nelson A.J., Makhni E.C., Davis J.J. Reconsidering Strategies for Managing Chronic Periprosthetic Joint Infection in Total Knee Arthroplasty: Using Decision Analytics to Find the Optimal Strategy Between One-Stage and Two-Stage Total Knee Revision. J Bone Joint Surg Am. 2019;101(1):14-24. doi: 10.2106/JBJS.17.00874.

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