Outcome of guided persistent fistula as a salvage procedure in patients with chronic periprosthetic joint infection.

BACKGROUND

Periprosthetic joint infection (PJI) is a challenging complication of arthroplasty. When curative treatment is not feasible, palliative alternatives may be considered. The aim of this study was to evaluate the outcomes of guided persistent fistula (GPF) as a salvage procedure for chronic PJI, focusing on treatment failure, prosthesis retention, and functional preservation.

METHODS

A retrospective observational study was conducted across five French regional referral centres. Adult patients with chronic PJI treated with GPF as a palliative measure were included. The primary outcome was treatment failure, defined as the occurrence of any major or minor adverse event during follow-up. Secondary outcomes included prosthesis retention, need for major salvage procedures, and ambulatory function. Clinical, microbiological, and outcome data were retrospectively collected.

RESULTS

A total of 51 patients (22 men, 29 women) with a mean age of 75.9 years (range, 48-95) were included. Staphylococcus aureus was the predominant pathogen identified at the infection site. An adjunctive suppressive antibiotic therapy was administered in 11 patients. During follow-up, 21 patients (41.2%) experienced adverse events, including eight minor events (15.7%) requiring re-fistulation and 13 major events (25.5%), comprising two deaths (3.9%), seven prosthesis removals (13.7%), and four amputations (7.8%). Thirty patients (58.8%) remained event-free. Excluding the two deaths, prosthesis retention was achieved in 38 of 49 surviving patients (77.6%).

CONCLUSION

GPF may represent a palliative treatment option for selected patients with chronic PJI when curative treatment is not feasible, allowing prosthesis retention in a substantial proportion of cases.