Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study

Introduction: Two-stage revision surgery is the most frequently performedprocedure in patients with a chronic periprosthetic joint infection (PJI).The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies.The aim of this study was to retrospectively evaluate the infectioneradication rate in patients with chronic PJI treated with two-stagerevision surgery of the hip or knee in primary and re-revision cases.Methods: All patients treated with a two-stage revision for chronic PJIbetween 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at lastfollow-up. Successful eradication is specified as no need for subsequentrevision surgery or suppressive antibiotic treatment.Results: Forty-seven patients were treated with a two-stage revision.Infection eradication was achieved in 36 out of 47 cases. Thirty-eightpatients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27-186) months. For hip andknee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in29 out of 38 cases and after re-revision in 7 out of 9 cases. Conclusion: In this study, the infection eradication rate for two-stagerevision surgery after PJI of the hip and knee in primary and re-revisioncases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infectioneradication rates at long-term follow-up of 128 (27-186) months.