Lower Reported Success Rates of Two-Stage Revisions for Periprosthetic Joint Infections Using Musculoskeletal Infection Society Outcome Reporting Tool at a Specialty Referral Center.

Abstract

The gold standard treatment for total hip arthroplasty (THA) periprosthetic joint infection (PJI) is a two-stage revision. Reported success rates are greater than 80%; however, significant differences remain in how treatment success rates are defined. The purpose of this study was to evaluate our specialized, tertiary hospital's experience with planned two-stage revisions for complex THA PJI. Consecutive patients who underwent a planned two-stage revision for THA PJI at our institution over a 13-year period were assessed. Patients had a minimum two-year follow-up, and those who had unplanned spacer retention were included. The primary outcome was treatment success defined by the Delphi Criteria and Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT; Tiers 1 and 2). Failure for reimplantation (Tier 3F) was recorded. Baseline characteristics were collected. Factors associated with treatment outcome were analyzed. A total of 67 patients were identified at a mean follow-up of 8.6 years (range, 2.5 to 15.0). There were 16 patients who underwent previous surgeries for their PJI (23.9%). Utilizing the MSIS ORT criteria, treatment success was achieved in 39 patients (58.2%) with reimplantation (Tier 1: 37 (55.2%), Tier 2: two (3%)). In contrast, an 86.6% success rate was noted when utilizing the Delphi criteria. 18 patients did not proceed with reimplantation and retained their spacers (Tier 3F). There were three patients (4.5%) who died during PJI treatment, and 20 patients (29.9%) who were placed on chronic antibiotic suppression. Considering infection control with and without reimplantation, overall treatment success was achieved in 57 patients (85.1%). Our study suggests that two-stage revisions at specialized PJI referral centers may be less successful than previously reported and highlights discrepancies between reporting measures. As PJI care moves towards specialized PJI centers, where spacer retention may be more prevalent, there is a need for consistent and transparent reporting of outcomes when treating complex cases.