Observational studyFrontiers in cellular and infection microbiology2026
Reinfection and re-revision rates of periprosthetic knee infection under four different surgical strategies: a single centre retrospective observational study.
Observational study in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Management strategies for (suspected) periprosthetic joint infection after total knee arthroplasty (TKA-PJI) include debridement, antibiotics, and implant retention (DAIR); one-stage revision; 1.5-stage revision; and two-stage revision. Reported outcomes for these four approaches vary widely across studies, with failure rates ranging from 0% to 40%. This study aims to compare the four strategies in terms of reinfection rates, microbial profiles of recurrent infections, short- and long-term infection-free prosthesis survival, re-revision rates for any cause, and long-term implant loosening-free survival. Methods: We conducted a retrospective cohort analysis of 145 patients who underwent DAIR, one-stage revision, 1.5-stage revision, or two-stage revision for TKA-PJI at our centre between October 2012 and October 2022. All patients had a minimum follow-up of 2 years. Diagnosis of PJI was based on the Musculoskeletal Infection Society (MSIS) criteria for PJI. Results: After a median follow-up of 99 (35, 164)months, infection recurred in 25 cases (18.8%). Of these, 7 cases (5.3%) were defined as relapses (same organism as the initial revision), 14 cases (10.5%) as new infections (different organism), and 4 cases (3.0%) had indeterminate infection type. In 5 patients DAIR successfully eradicated the reinfection. After overall follow-up 25 patients (18.8%) underwent re-revision surgery, 17 patients (12.8%) due to an infection and 8 patients (6.0%) for aseptic reasons. The cumulative reinfection rates at 2 years after DAIR, one-stage revision,1.5-stage revision, and two-stage revision was 14.6% (95% CI: 7.8% to 15.1%), 16.0% (95% CI: 9.7% to 21.2%), 13.8% (95% CI: 8.4% to 18.9%), and 4.0% (95% CI: 3.0% to 11.1%), respectively; at 5 years was 18.4% (95% CI: 9.2% to 16.4%), 20.8% (95% CI: 11.6% to 22.2%), 17.9% (95% CI: 10.0% to 19.8%), and 17.0% (95% CI: 8.1% to 14.1%), respectively. Overall, the cumulative reinfection rates at 2 and 5 years was 11.0% vs. 18.2% (χ2 = 2.950, Conclusion: Treatment of a (suspected) TKA-PJI by four strategies-DAIR, one-stage, 1.5-stage, and two-stage revision-had acceptable results based on re-revision and reinfection rates in the long-term (>5 years), resembling the short-term results (<2 years). Focussing on the cultures at the time of initial revision, the incidence of new infections during follow-up was twice that of relapses. Reinfection rates were higher in cases with positive cultures at reimplantation. Patients should be counselled appropriately in this particular situation.
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