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Updated: Jun 29, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Risk factors for recurrence of periprosthetic joint infection following operative management: a cohort study with
Seper Ekhtiari1, Aaron Gazendam1, Ahmed Saidahmed1
1Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Background:
Periprosthetic joint infections (PJIs) remain challenging to eradicate even after surgical management, which in most cases involves either debridement, antibiotics and implant retention (DAIR) or single- or two-staged revision. The purpose of this study is to determine predictors of PJI recurrence after operative management for PJI, and to determine differences in recurrence-free survival between DAIR and staged revision.
Methods:
This is a retrospective analysis of prospectively collected data of revision hip and knee arthroplasty surgeries due to PJI between 2011 and 2018 at an academic hospital. Any patient undergoing revision surgery for PJI was included except if the index surgery information was unknown. The primary outcome was confirmed PJI recurrence. Multivariable logistic regression analysis was utilized to determine the relationship between the predictor variables and outcome variable. Log rank testing was used to compare recurrence-free survival between DAIR and staged revision.
Results:
A total of 89 patients (91 joints) underwent revision surgery due to PJI. Younger age and presence of a sinus tract were statistically significant for risk of PJI recurrence. A multivariable logistic regression model including both variables was significant for predicting recurrence of PJI (χ2=10.2, P=0.006). Survival was not significantly different between patients who underwent DAIR versus a staged revision.
Conclusions:
Younger patients and those with a chronic sinus tract are at significantly higher risk of recurrent PJI. This study also demonstrated that PJI can be successfully managed in the majority of cases with DAIR or staged revision.
Insights
Younger patients and those with a sinus tract face higher risks of periprosthetic joint infection (PJI) recurrence after surgery. Both debridement, antibiotics and implant retention (DAIR) and staged revision offer comparable outcomes for managing PJI.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Arthroplasty revision
Background:
- Periprosthetic joint infections (PJIs) present significant challenges in eradication post-surgery.
- Current management strategies include debridement, antibiotics and implant retention (DAIR) or staged revision surgery.
Purpose of the Study:
- Identify predictors of PJI recurrence following operative management.
- Compare recurrence-free survival rates between DAIR and staged revision procedures.
Main Methods:
- Retrospective analysis of prospectively collected data from revision hip and knee arthroplasty for PJI (2011-2018).
- Multivariable logistic regression and log-rank testing were employed to analyze recurrence predictors and survival differences.
Main Results:
- Younger age and the presence of a sinus tract were significant predictors of PJI recurrence.
- A multivariable model incorporating these factors effectively predicted PJI recurrence (χ²=10.2, P=0.006).
- No significant difference in recurrence-free survival was observed between DAIR and staged revision groups.
Conclusions:
- Younger patients and those with chronic sinus tracts have a higher risk of recurrent PJI.
- Both DAIR and staged revision are effective in managing PJI, with comparable outcomes in this cohort.
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