Predictors of Reinfection in Prosthetic Joint Infections Following Two-Stage Reimplantation

Curtis W. Hartman, Eric C. Daubach, Brian T. Richard, Elizabeth R. Lyden, Hani Haider, Beau J. Kildow, Beau S. Konigsberg, Kevin L. Garvin

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Two-stage reimplantation is an effective treatment for periprosthetic joint infection (PJI). Many factors are involved in the variable success of this procedure. The purpose of this study is to examine the relationship between patient risk factors, comorbidities, and the pathogen on reinfection rates following two-stage reimplantation. Methods: We evaluated 158 patients treated for PJI from 2008-2019. Only patients who had completed a two-stage exchange were included. Patient demographics, comorbidities, laboratory values, time-to-reimplantation, pathogen, antibiotic sensitivities, host status, and reinfection rates were assessed. Multivariate analysis was performed to identify correlation between risk factors and reinfection. A P-value <.05 was considered statistically significant. Results: 31 patients experienced a reinfection (19.6%). There was a statistically significant association between infection with Methicillin Sensitive Staphylococcus Aureus (MSSA) and reinfection (P =.046). Patients with a reinfection also had a significantly greater median serum C-reactive protein (CRP) level (12.65 g/dL) at the time of diagnosis compared to patients without a reinfection (5.0 g/dL) (P =.010). Median Erythrocyte Sedimentation Rate (ESR) (56 in no re-infection and 69 in re-infection) and time-to-reimplantation (101 days in no reinfection and 141 days in reinfection) demonstrated a trend toward an association with re-infection but were not statistically significant (P =.055 and P =.054 respectively). Conclusion: As the number of arthroplasties continue to rise, PJIs are increasing proportionately and represent a significant revision burden. Elevated C-reactive protein (CRP) levels and Methicillin Sensitive Staphylococcus aureus (MSSA) infection were strongly associated with failure of a two-stage reimplantation. While not statistically significant with our numbers, there were strong trends toward an association between elevated Erythrocyte Sedimentation Rate (ESR), longer time-to-reimplantation, and reinfection.

Original languageEnglish (US)
Pages (from-to)S674-S677
JournalJournal of Arthroplasty
Issue number7
StatePublished - Jul 2022


  • hip infection
  • hip revision
  • knee infection
  • knee revision
  • periprosthetic infection
  • prosthetic joint infection
  • two-stage reimplantation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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