Mid-term Results of 1-stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection With a Sinus Tract

Patients presenting with a sinus tract over total knee arthroplasty (TKA) are challenging cases of periprosthetic joint infection (PJI). A 2-stage revision TKA has long been considered the gold standard for the management of PJI. At our institution, approximately 85% of patients with PJI, including patients with a sinus tract, undergo 1-stage revision TKA. We sought to evaluate rates of reinfection and reoperation and predictors of failure of 1-stage revision TKA in patients with a concomitant sinus tract. We retrospectively reviewed patients with PJI and a sinus tract overlying TKA who underwent 1-stage revision TKA following a well-defined surgical protocol at our institution between January 2001 and December 2018. Of 170 patients included, 69 patients (40.6%) had a sinus tract overlying TKA; 101 patients without a sinus were the propensity-matched control group. The success rate of controlling reinfection with 1-stage revision TKA with a concomitant sinus was 78.3% with a mean follow-up of 4.8 years. The most common intraoperatively isolated organisms in patients with a sinus tract were coagulase-negative Staphylococcus in 28 patients (40.6%), Staphylococcus aureus in 12 patients (17.2%), and polymicrobial infection in 14 patients (20.3%). A sinus tract in line with the surgical wound was associated with a higher risk of reoperation than a sinus tract away from the wound. Our retrospective study suggests that 1-stage revision TKA may be a viable treatment option for patients presenting with a sinus tract. A sinus in line with the former incision was associated with a higher rate of revision. Surgeons should take into consideration this risk for revision before performing a 1-stage exchange surgery.