Risk factors predicting the reinfection in periprosthetic joint infection with sinus tracts following prosthesis removal and antibiotic bone cement spacer implantation

Background: The sinus tract has been demonstrated to be a factor affecting the efficacy of periprosthetic joint infection (PJI). Reinfection after prosthesis removal and antibiotic bone cement spacer implantation is one of the reasons for the failure of two-stage arthroplasty. The purpose of this study was to investigate the risk factors predicting the reinfection in periprosthetic joint infection with sinus tracts following prosthesis removal and antibiotic bone cement spacer implantation. Methods: Clinical data of 35 PJI patients with sinus tract from February 2003 to December 2021 in our hospital were retrospectively analyzed. Follow-up was discontinued either (1) when patients developed reinfection before completing the second stage of the two-stage revision or (2) when patients were free of infection 2-years postoperatively, regardless of whether they had completed the two-stage revision. The sinus tract is defined as an abnormal channel with evidence of communication to the joint or visualization of the prosthesis. Postoperative reinfection was defined as meeting the diagnostic criteria for PJI, including requiring hospitalization for intravenous antibiotics or surgeries to prevent infection. The Multifactor Cox proportional risk model was used to analyze the risk factors. Results: Of the 35 patients, 14 (40.0%) of PJI patients with one or more sinus tracts developed reinfection after removal of prostheses and implantation of antibiotic bone cement spacers. Multivariate analysis showed that age (p = 0.044), C-reactive protein (p = 0.023) and uric acid (p = 0.025) were independent risk factors. Conclusion: We found the following factors associated with reinfection in periprosthetic joint infection with sinus tracts following prosthesis removal and antibiotic bone cement spacer implantation: age, C-reactive protein and uric acid.