Lower Reported Success Rates of Two-Stage Revisions for Periprosthetic Joint Infections Using Musculoskeletal...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Arthroplasty Outcomes

Background:

• Total hip arthroplasty (THA) periprosthetic joint infection (PJI) is a significant complication.
• Two-stage revision is the gold standard treatment, with reported success rates exceeding 80%.

Purpose of the Study:

• To evaluate the outcomes of planned two-stage revisions for complex THA PJI at a specialized tertiary hospital.
• To assess treatment success using different reporting criteria.

Main Methods:

• A retrospective review of 67 patients undergoing planned two-stage revision for THA PJI over 13 years.
• Minimum 2-year follow-up, including patients with unplanned spacer retention.
• Treatment success assessed using Delphi Criteria and Musculoskeletal Infection Society Outcome Reporting Tool (MSIS-ORT).

Main Results:

• Using MSIS-ORT, success was 58.2% (Tier 1 & 2); using Delphi criteria, success was 86.6%.
• Overall treatment success, including infection control with or without reimplantation, was 85.1% (57 patients).
• 18 patients (26.9%) retained spacers, 3 (4.5%) died, and 20 (29.9%) received chronic antibiotic suppression.

Conclusions:

• Two-stage revisions at specialized PJI centers may yield lower success rates than previously suggested.
• Significant discrepancies exist between different outcome reporting measures for THA PJI.
• Standardized outcome reporting is crucial for complex PJI management in specialized centers.