Time to Reimplantation: Waiting Longer May Increase the Risk of Subsequent Failure

Area of Science:

• Orthopaedic Surgery
• Infectious Disease Management
• Biomedical Engineering

Background:

• Periprosthetic joint infection (PJI) management often involves two-stage exchange arthroplasty.
• Limited research exists on the optimal timing between resection and reimplantation in PJI treatment.
• Understanding this interval's impact on treatment success is critical for patient outcomes.

Purpose of the Study:

• To investigate the association between the time from resection arthroplasty to reimplantation and treatment outcomes in patients undergoing two-stage exchange for PJI.
• To identify if the duration of the interstage period influences the risk of failure after a two-stage exchange procedure.

Main Methods:

• Retrospective analysis of 576 patients with chronic knee PJI undergoing two-stage exchange.
• Exclusion of patients with reimplantation >180 days post-resection and those with spacer exchange.
• Definition of PJI using 2013 MSIS criteria; treatment failure defined as reoperation for infection or PJI-related mortality.
• Multivariate regression analyses to identify predictors of treatment failure.

Main Results:

• Analysis included 451 patients with a mean follow-up of 5.8 years; 15.7% experienced treatment failure.
• A 22% increased risk of failure was observed for every 10-day increase in the time to reimplantation.
• Interstage durations <76 days were independently associated with a higher likelihood of treatment success (OR 0.23).

Conclusions:

• Prolonging the interval between resection and reimplantation in two-stage exchange for PJI is linked to increased treatment failure rates.
• An interstage duration of less than 76 days significantly enhances the probability of successful two-stage exchange outcomes.
• Optimizing the timing of reimplantation is a key factor in improving success rates for PJI management.