ArticleBMC musculoskeletal disorders2026
One-stage exchange arthroplasty for periprosthetic joint infection following total knee arthroplasty with sinus tract: a mid-to short-term follow-up study.
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAn increasing amount of clinical evidence indicates that one-stage exchange arthroplasty provides outcomes comparable to those of two-stage exchange arthroplasty in the management of chronic periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). However, for cases complicated by a sinus tract, most specialists still advocate a two-stage exchange arthroplasty strategy. This study aims to evaluate the effectiveness of one-stage exchange arthroplasty in treating chronic PJI following TKA with sinus tract formation and to determine the feasibility of this approach in achieving infection control and restoring joint function.
methodsA retrospective analysis was conducted on 23 patients with PJI following TKA accompanied by a sinus tract, who were admitted between January 1, 2019 and December 31, 2023. All patients completed a minimum follow-up of 12 months. During this period, microbiological findings, individualized antimicrobial regimens, and incidences of infection recurrence were meticulously documented. To objectively evaluate infection control, serial measurements of serum inflammatory markers—including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT)—were obtained preoperatively and on postoperative days 3, 7, 10, and 14, allowing for assessment of their dynamic changes. Furthermore, to assess functional recovery, the visual analog scale (VAS) score, knee range of motion (ROM), and Knee Society Score (KSS) were compared preoperatively and at postoperative day 14, 3 months, and the final follow-up.
resultsThe mean follow-up duration was 14.0 ± 0.9 months. At the final follow-up, the infection-free survival rate was 95.65% (22/23) as defined by the International Consensus Meeting (ICM) criteria, with only one case of recurrence at two months postoperatively. All evaluated clinical outcomes—including the VAS score, ROM, and KSS—demonstrated statistically significant improvements compared to preoperative baseline values (P < 0.001). By the final follow-up, patients had achieved a nearly pain-free state. The mean knee ROM significantly increased from 64.8° ± 5.0° preoperatively to 120.0° ± 4.5°, while the mean KSS improved from 33.1 ± 5.3 points to 87.7 ± 5.2 points.
conclusionFor chronic PJI following TKA with a sinus tract, one-stage exchange arthroplasty, when performed in strict adherence to a standardized protocol, demonstrates favorable potential in infection control and significant functional restoration, with satisfactory medium-term outcomes. Therefore, under strictly standardized surgical protocols, one-stage exchange arthroplasty may be considered a viable treatment option for carefully selected cases of periprosthetic joint infection complicated by a sinus tract following thorough and prudent evaluation.
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