Treatment of periprosthetic joint infection - outcomes following algorithm-guided treatment at a multidisciplinary...

Introduction: This study evaluated early treatment outcomes and the management of complications in patients with periprosthetic joint infection (PJI) of the hip and knee treated at a specialized centre using an algorithm-guided multidisciplinary team (MDT) approach. Methods: This prospective cohort includes all consecutive patients treated for acute or chronic PJI between December 2019 and December 2022, with a minimum 1-year follow-up. PJI was defined according to the criteria of the European Bone and Joint Infection Society (EBJIS). Surgical decisions were based on a published treatment algorithm. The primary outcome was treatment success at 1 year after the last PJI surgery. Results: 106 patients were included according to prespecified criteria, with a median age of 74 years (IQR 66-82) and follow-up of 24 months (IQR 15-28). 79 patients (75 %) were referred from other institutions. 44 patients (42 %) were treated with debridement, antibiotics, and implant retention (DAIR); 17 (16 %) were treated with one-stage revision; and 45 (42 %) were treated with two-stage revision. 9 patients (8 %) needed plastic surgery for soft tissue reconstruction. The 1-year infection-free survival (Delphi-based consensus criteria) was 69 % (95 % CI: 60 %-78 %). Within 1 year, 14 (13.2 %) septic and 12 (11.3 %) aseptic failures occurred after a median of 0.5 months (IQR 0.4-1) and were successfully treated in most patients. 12 patients (11 %) died after a median of 0.8 months (IQR 0.3-2.8). Conclusion: Our results demonstrate the value of an algorithm-driven MDT approach as an effective strategy for managing complex PJI patients and PJI-surgery-related complications in a specialized referral centre for bone and joint infections.