Articles | Volume 11, issue 4
https://doi.org/10.5194/jbji-11-513-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-11-513-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Reinfection and complication rates in two-stage revision for chronic hip periprosthetic joint infections using the direct anterior approach
Sebastian Simon
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
Center for Musculoskeletal Infections, University Hospital Basel, Basel, 4031, Switzerland
Jennyfer A. Mitterer
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
Center for Musculoskeletal Infections, University Hospital Basel, Basel, 4031, Switzerland
Bernhard J. H. Frank
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
Stephanie Huber
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
Sujeesh Sebastian
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Susana Gardete-Hartmann
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Vienna, Austria
Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
Second Department, Orthopedic Hospital Vienna Speising, Vienna, Austria
School of Medicine, Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria
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Ece Akcicek, Jennyfer A. Mitterer, Veronika Achatz, Tamino Szirmay, Sujeesh Sebastian, and Jochen G. Hofstaetter
J. Bone Joint Infect., 11, 83–94, https://doi.org/10.5194/jbji-11-83-2026, https://doi.org/10.5194/jbji-11-83-2026, 2026
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Pseudomonas aeruginosa is a common pathogen in Gram-negative periprosthetic joint infections (PJIs). It is resistant to many antibiotics and forms biofilm, making it difficult to treat. We analyzed 1286 patients who underwent 1640 surgeries; among them, 38 patients with 50 procedures had P. aeruginosa. Most infections were chronic, often in hip revisions, with a high failure rate and recurrence. Due to its clinical and microbiological features, P. aeruginosa-related PJIs remain challenging.
Sujeesh Sebastian, Hibah A. Abusulaiman, Veronika Achatz, Matteo Spadini, Jennyfer A. Mitterer, Sebastian Simon, and Jochen G. Hofstaetter
J. Bone Joint Infect., 11, 15–19, https://doi.org/10.5194/jbji-11-15-2026, https://doi.org/10.5194/jbji-11-15-2026, 2026
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A simple, rapid, and low-cost test measuring synovial fluid specific gravity shows high accuracy and excellent specificity for diagnosing hip and knee periprosthetic joint infection. This method can quickly help rule in infections during revision surgeries, making it a practical point-of-care tool, especially in clinics or hospitals with limited resources. Its performance supports use alongside established lab markers for better patient outcomes.
Veronika Achatz, Jennyfer A. Mitterer, Stephanie Huber, Ece Akcicek, Selma Tobudic, Sujeesh Sebastian, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 265–275, https://doi.org/10.5194/jbji-10-265-2025, https://doi.org/10.5194/jbji-10-265-2025, 2025
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Proteus is a rare form of bacteria in periprosthetic joint infection (PJI) following knee and hip arthroplasties. In this study, we investigated culture-positive revision surgeries from 2008 until 2024. Proteus species were mainly found in hip arthroplasties. Furthermore, the infections of Proteus species were mainly prevalent in chronic revisions alongside multiple bacteria. Given their chronic and polymicrobial nature, the outcome of Proteus-associated PJIs is poor.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
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We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
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Short summary
Two-stage septic revision was evaluated in 36 / 8476 (0.4 %) patients after primary total hip arthroplasty (THA) using the direct anterior approach (DAA). Infection-free survival was 77.8 % after a median follow-up of 6 years. Spacer-related complications occurred in 5.6 %. Revision for dislocation after reimplantation occurred in 8.3 %. Two-stage septic revision using the DAA shows reinfection rates comparable to other approaches, with low rates of spacer dislocation and postoperative dislocation after reimplantation.
Two-stage septic revision was evaluated in 36 / 8476 (0.4 %) patients after primary total hip...