Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology

Abstract

Objectives: We describe rates of success for two-stage revision of prosthetic joint infection (PJI), including data on reimplantation microbiology.

Methods: We retrospectively collected data from all the cases of PJI that were managed with two-stage revision over a 4 year period. Patients were managed with an antibiotic-free period before reimplantation, in order to confirm, clinically and microbiologically, that infection was successfully treated.

Results: One hundred and fifty-two cases were identified. The overall success rate (i.e. retention of the prosthesis over 5.75 years of follow-up) was 83%, but was 89% for first revisions and 73% for re-revisions [hazard ratio = 2.9, 95% confidence interval (CI) 1.2-7.4, P = 0.023]. Reimplantation microbiology was frequently positive (14%), but did not predict outcome (hazard ratio = 1.3, 95% CI 0.4-3.7, P = 0.6). Furthermore, most unplanned debridements following the first stage were carried out before antibiotics were stopped (25 versus 2 debridements).

Conclusions: We did not identify evidence supporting the use of an antibiotic-free period before reimplantation and routine reimplantation microbiology. Re-revision was associated with a significantly worse outcome.

Figure 1

Kaplan–Meier plot showing survival of implants by older (≥70 years) versus younger (<70 years) patient age.

Figure 2

Kaplan–Meier plot showing survival of implants by primary implant versus previously revised implants.

Figure 3

Kaplan–Meier plot showing survival of implants by reimplantation culture results.