Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Mar;65(3):569-75.
doi: 10.1093/jac/dkp469. Epub 2010 Jan 6.

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

P Bejon  1 , A Berendt, B L Atkins, N Green, H Parry, S Masters, P McLardy-Smith, R Gundle, I Byren
Affiliations

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

P Bejon et al. J Antimicrob Chemother. 2010 Mar.

Erratum in

  • J Antimicrob Chemother. 2011 May;66(5):1204

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan–Meier plot showing survival of implants by older (≥70 years) versus younger (<70 years) patient age.
Figure 2
Figure 2
Kaplan–Meier plot showing survival of implants by primary implant versus previously revised implants.
Figure 3
Figure 3
Kaplan–Meier plot showing survival of implants by reimplantation culture results.
See this image and copyright information in PMC

References

    1. Lavernia CJ, Guzman JF, Gachupin-Garcia A. Cost effectiveness and quality of life in knee arthroplasty. Clin Orthop Relat Res. 1997;345:134–9. - PubMed
    1. Chang RW, Pellisier JM, Hazen GB. A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996;275:858–65. - PubMed
    1. Ethgen O, Bruyere O, Richy F, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86-A:963–74. - PubMed
    1. Phillips CB, Barrett JA, Losina E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am. 2003;85-A:20–6. - PubMed
    1. Sibanda N, Copley LP, Lewsey JD, et al. Revision rates after primary hip and knee replacement in England between 2003 and 2006. PLoS Med. 2008;5:e179. - PMC - PubMed

Publication types

Substances