Higher reinfection rate after two-stage revision arthroplasty in patients with refractory diabetes mellitus: a retrospective analysis with a minimum ten-year follow up

Lin, Yu-Chih; Lin, Yi‐Hsuan; Chou, Jian-Hong; Lo, Yu-Tai; Chang, Chih‐Hsiang; Lee, Sheng-Hsun; Lin, Sheng‐Hsuan

doi:10.1186/s12891-022-05964-9

Cited by 5 publications

(2 citation statements)

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“…The definition of PJI evolved during the study period: before 2011, it was based on a positive culture from at least two separate tissue samples from the knee joint. Post 2011, PJI was defined according to the MSIS criteria [ 24 ], and patients were treated following our institute's established protocols [ 19 ]. Acute hematogenous PJI was categorized by the acute onset of PJI symptoms and signs lasting no longer than four weeks prior to DAIR [ 30 ].…”

Section: Primary and Secondary Endpointsmentioning

confidence: 99%

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Impact of unplanned second debridement, antibiotics and implant retention on long‐term outcomes in knee exchange arthroplasty: Elevated risk of failure and reinfection

Lin,

Chen,

Peng

et al. 2024

J. exp. orthop.

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PurposeThis study investigates the outcomes of two‐stage exchange arthroplasty (EA) for periprosthetic joint infection (PJI) following initial or unplanned repeat debridement antibiotics, and implant retention (DAIR).MethodsWe retrospectively reviewed cases of knee arthroplasty infection treated with two‐stage EA after DAIR, spanning from January 1994 to December 2010. A total of 138 patients were included, comprising 112 with initial DAIR and 26 with an unplanned second DAIR. Data on demographics, comorbidities, infection characteristics and causative organisms were analyzed. The primary outcome was implant failure or reinfection, observed over a minimum follow‐up of 10 years.ResultsThe overall success rate for two‐stage EA was 87% (119/138 patients). Factors identified for treatment failure included reinfection with the same pathogen for unplanned second DAIR (hazard ratio [HR] = 3.41; 95% confidence interval [CI] = 1.35–4.38; p = 0.004), higher reinfection rates in patients undergoing EA after an unplanned second DAIR, especially with a prior history of PJI within 2 years (HR = 4.23; 95% CI = 2.39–5.31; p = 0.002), pre‐first DAIR C‐reactive protein (CRP) levels over 100 mg/dL (HR = 2.52; 95% CI = 1.98–3.42; p = 0.003) and recurrence with the same pathogen (HR = 2.35; 95% CI = 1.32–4.24; p = 0.007). Additional factors such as male gender (HR = 3.92; 95% CI = 1.21–5.25; p = 0.007) and osteoporosis (T score < −2.5; HR = 3.27; 95% CI = 1.23–5.28; p = 0.005) were identified as risk factors for implant failure in all EA cases.ConclusionsThis study identifies key risk factors for worse knee EA outcomes following DAIR, including a pre‐first DAIR CRP level over 100 mg/L, same pathogen recurrence, and PJI history within 2 years. It shows implant failure rates remain constant across EA cases, regardless of DAIR sequence, particularly with risk factors like male gender and severe osteoporosis (T score < −2.5). These results underscore the need for careful evaluation before an unplanned second DAIR, given its significant impact on EA success.Level of EvidenceLevel III.

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Section: Primary and Secondary Endpointsmentioning

confidence: 99%

“…Acute hematogenous PJI was categorized by the acute onset of PJI symptoms and signs lasting no longer than four weeks prior to DAIR [ 30 ]. In contrast, symptoms present for more than 4 weeks indicate a chronic infection, for which the preferred treatment is two‐stage EA [ 19 , 25 ].…”

Section: Primary and Secondary Endpointsmentioning

confidence: 99%