title: Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology.
abstract: OBJECTIVE
  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.
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. pbejon@well.ox.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Bejon
authors.forename: A
authors.initials: A
authors.lastname: Berendt
authors.forename: B L
authors.initials: BL
authors.lastname: Atkins
authors.forename: N
authors.initials: N
authors.lastname: Green
authors.forename: H
authors.initials: H
authors.lastname: Parry
authors.forename: S
authors.initials: S
authors.lastname: Masters
authors.forename: P
authors.initials: P
authors.lastname: McLardy-Smith
authors.forename: R
authors.initials: R
authors.lastname: Gundle
authors.forename: I
authors.initials: I
authors.lastname: Byren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D012092:Replantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents