The true fate of the 2-stage revision arthroplasty for hip and knee prosthetic joint infection

BACKGROUND: 2-stage revision arthroplasty remains the current gold standard for treatment of chronic periprosthetic joint infection (PJI) of the hip and knee in the United States. Rates of infection eradication have been shown to vary from 60% to 91%. The purpose of this study was to determine the true fate the of 2-stage exchange protocol for PJI using an updated classification system for PJI treatment outcomes as well as the effect of systemic host and local extremity grades on outcomes. METHODS: A retrospective review of a PJI registry was performed from a single institution from January 2010 through December 2021. All patients having undergone a planned 2-stage exchange after primary or revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) for chronic PJI defined by Musculoskeletal Infection Society criteria were included. Perioperative variables and tiered outcome at final follow up were collected. RESULTS: In total, 589 cases (561 patients) met final inclusion criteria and were included in the analysis. 394 cases (66.9%) retained their implants at median follow-up of 3.7 years (IQR 1.8, 7.7). 311 cases (52.8%) underwent successful two-stage revision with prosthesis retention without ongoing use of suppressive antibiotics, while another 83 cases (14.1%) retained their prosthesis with use of suppressive antibiotics. 152 cases (25.8%) underwent subsequent septic or aseptic revision, amputation, arthrodesis, spacer retention while 40 (6.8%) died during the study period. CONCLUSIONS: At 3.7 years after surgery, 66.9% of 2-stage exchanges for PJI resulted in retained prosthesis with or without use of suppressive antibiotics. The remaining 33.1% of this population underwent additional surgery (25.8%), or were deceased (6.8%).