title: Periprosthetic Infection Recurrence After 2-Stage Exchange Arthroplasty: Failure or Fate?
abstract: Two-stage exchange arthroplasty remains the preferred method for treating a chronic periprosthetic joint infection (PJI) in North America. However, infection recurrence may occur. Previously, recurrent infections have been classified as persistent (same isolated pathogen) or new (different pathogen identified). We sought to determine (1) recurrence rates among patients with chronic hip and knee PJI, treated with 2-stage exchange arthroplasty; (2) risk factors for infection recurrence; and (3) risk factors for developing persistent vs new infection.
  
  
  
  We retrospectively reviewed clinical characteristics of patients with chronic hip and knee PJI, treated with 2-stage revision between January 1998 and March 2014. Minimum follow-up was 24 months. Two multivariate logistic regression models were constructed to determine independent predictors for infection recurrence and persistence.
  
  
  
  In total, 548 patients were identified (283 men, 265 women). Forty-eight had a recurrent infection (8.76%). Men had 54.8% lower odds of PJI recurrence than women (odds ratio [OR] = 0.452; 95% confidence interval [CI], 0.235-0.869). Patients with heart disease had 109% higher odds of infection recurrence than patients without heart disease (OR = 2.09; 95% CI, 1.097-3.081). The risk of infection recurrence was 119% higher in patients with psychiatric disorders than in patients without psychiatric disorders (OR = 2.19; 95% CI, 1.011-4.761). Patients with recurrent knee PJI had 84.6% lower odds of persistent infection (OR = 0.154; 95% CI, 0.034-0.696) compared to hip PJI. Patients with heart disease had 5-fold increased odds for persistent PJI (OR = 5.068; 95% CI, 1.38-22.56).
  
  
  
  Female gender, heart disease, and psychiatric disorders increase the risk of hip and knee PJI recurrence. Patients with PJI of the hip and with heart disease are at higher risk of infection persistence.
authors.affiliation: Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Triantafyllopoulos
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.affiliation: Epidemiology and Biostatistics Core, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Epidemiology and Biostatistics Core, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sculco
authors.affiliation: Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Lazaros A
authors.initials: LA
authors.lastname: Poultsides
mesh_terms: D000368:Aged; D001170:Arthritis, Infectious / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009656:North America; D016017:Odds Ratio; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: chronic; periprosthetic joint infection; recurrence; two-stage revision