Risk Factors for Treatment Failure in Patients Who Have Knee Periprosthetic Joint Infection Treated With Two-Stage Exchange Arthroplasty as Well as Their Fate

Yi Chen Chen, Yu Chih Lin, Chih Hsiang Chang, Sheng Hsun Lee, Yuhan Chang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

7 Scopus citations

Abstract

BACKGROUND: Two-stage exchange arthroplasty is considered the gold standard treatment for chronic periprosthetic joint infection (PJI). However, there is a scarcity of research investigating the major risk factors for infection recurrence and the prognosis after infection recurrence.

METHODS: This study included 203 patients who underwent 2-stage exchange arthroplasty between June 22, 2010 and January 24, 2017. The need of reoperation for infection-related or PJI-related mortality was considered treatment failure. Participant age, gender, body mass index, comorbidities, culture results, length of hospital stay, cause of treatment failure, operative procedure, and fate were analyzed.

RESULTS: Fifty-three patients experienced treatment failure (26.1%). Mean follow-up was 63 months (range, 26-103). Based on the multivariate analyses, risk factors for treatment failure included men and positive intraoperative culture during reimplantation. Recurrent infection was most commonly caused by Staphylococcus aureus (32.1%, 17/53), and new microorganisms caused recurrent infection in 34 of 53 (64.2%) patients. In 44 patients who had treatment failure, debridement, antibiotic therapy, irrigation, and retention of prosthesis (DAIR) performed within 6 months of reimplantation and at <3 weeks from symptom onset resulted in a significantly higher success rate than the use of other DAIR protocols (P = .031).

CONCLUSION: Men and positive intraoperative culture are major risk factors for 2-stage exchange arthroplasty failure in patients who have knee PJI. Recurrent infection in these patients is usually caused by new microorganisms. DAIR within 6 months of reimplantation and at <3 weeks from symptom onset results in good outcomes in these patients.

Original languageEnglish
Pages (from-to)355-360
Number of pages6
JournalJournal of Arthroplasty
Volume38
Issue number2
DOIs
StatePublished - 02 2023

Bibliographical note

Copyright © 2022. Published by Elsevier Inc.

Keywords

  • 2-stage exchange arthroplasty
  • knee periprosthetic joint infection
  • prognosis
  • recurrent infection
  • risk factor
  • Arthroplasty, Replacement, Knee/adverse effects
  • Debridement/adverse effects
  • Humans
  • Risk Factors
  • Male
  • Treatment Outcome
  • Reoperation/adverse effects
  • Prosthesis-Related Infections/etiology
  • Reinfection/complications
  • Treatment Failure
  • Retrospective Studies
  • Anti-Bacterial Agents/therapeutic use

Fingerprint

Dive into the research topics of 'Risk Factors for Treatment Failure in Patients Who Have Knee Periprosthetic Joint Infection Treated With Two-Stage Exchange Arthroplasty as Well as Their Fate'. Together they form a unique fingerprint.

Cite this