The re-infection rate over time following two-stage revision knee arthroplasty for peri-prosthetic joint infection: A retrospective review of 130 knees at minimum 4-year follow-up.

Abstract

This study aimed to identify the risk of reinfection, the risk factors associated with reinfection and the microbiological, surgical, and patient factors associated with failure in two-stage revision surgery for prosthetic joint infection. 130 knees undergoing two-stage revision arthroplasty for prosthetic joint infection between 2004-20 from a single centre with a minimum four-year follow-up (range 4-21 years) were identified. Re-infection, the risk of prosthesis explanation and mortality were analysed using Kaplan-Meier survivorship graphs. Univariant and multivariate analyses were performed to identify any association between re-infection and patient, microbiological or surgical factors. Reinfection rates were compared for knees undergoing two-stage revision surgery for infection in patients following simple primary arthroplasty and those following revision arthroplasty surgery or where a complex primary had been carried out following fracture fixation. There was a 17% reinfection rate with reinfection occurring up to 10 years after the two-stage revision surgery. Of the re-infected knees, 77% underwent prosthesis explantation. The 5 and 10-year mortality rates were 5.4% and 24.1% respectively. The Charlson Co-morbidity Index, number or type of organisms, growth of organisms at second-stage, degree of bony defect or need for soft tissue flap coverage had no association with the risk of re-infection. Two-stage revision arthroplasty remains an effective surgical option to treat PJI. Reinfection, however, can occur up to 10 years following apparent successful eradication surgery.