Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology.
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.
Bejon
P
P
Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. pbejon@well.ox.ac.uk
Berendt
A
A
Atkins
B L
BL
Green
N
N
Parry
H
H
Masters
S
S
McLardy-Smith
P
P
Gundle
R
R
Byren
I
I
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
D000900:Anti-Bacterial Agents