Reinfection and re-revision rates of 113 two-stage revisions in infected TKA

Abstract. Introduction: Two-stage revision is the most frequently performed revision procedure of a (suspected) periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). The reported results of this treatment show large variability between studies, ranging between 0 - 40 percent failure. The purposes of this study were to determine long term (1) reinfection rate, (2) re-revision rates for any reason, and (3) the reinfection rate of patients with positive cultures at reimplantation.

Methods: We prospectively followed and retrospectively reviewed 113 consecutive two-stage revision TKAs, performed between 2003 and 2013 in our clinic with a minimum follow-up of 2 years. Diagnosis of PJI was based on the major Musculoskeletal Infection Society criteria for PJI.

Results: After a mean follow-up of 94 months (range 24-172 months), infection recurred in 23 cases (23%). Of these, nine cases (9%) were defined as relapse (same micro-organism as index revision) and in 14 cases another causative was found (14%). In 11 patients debridement, antibiotics and retention of the prosthesis successfully eradicated the reinfection. After overall follow-up 17 patients (17%) underwent re-revision surgery, 11 patients (11%) due to an infection and 6 patients (6%) for aseptic reasons.

Conclusions: Treatment of a (suspected) infection of a TKA by a two-stage revision had acceptable results based on re-revision and re-infection rates in the long term (>5 years), resembling the short-term results (<2 years). Focussing on the cultures at the index two-stage revision, episodes of relapse and new infections during follow-up were almost equally divided. Reinfection rates were higher in cases with positive cultures at reimplantation. Patients should be counselled appropriately in this particular situation.