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This multi-center retrospective study evaluated the success of repeat two-stage revision TKA for chronic PJI in 48 patients (61 initially) with a mean follow-up of 12.1 years. Treatment success, defined by 2019 MSIS criteria, was achieved in only 39.6% of cases, with 22.9% requiring amputation; 5- and 10-year implant survival for all-cause revision was 63.2% and 42.3%, respectively. Younger age was identified as an independent predictor of failure.
Repeat two-stage revision TKA for recurrent PJI demonstrates unacceptably low success rates and high amputation rates, particularly in younger patients.
INTRODUCTION Recurrent periprosthetic joint infection (PJI) after two-stage revision total knee arthroplasty remains challenging. Repeat two-stage revision is a salvage option, but outcomes are poorly defined. This multicenter study evaluated the success of repeat two-stage knee revision for chronic PJI. METHODS A retrospective review of prospectively maintained databases at two tertiary centers identified 61 patients treated between 1995 and 2022. There were 13 (21.3%) who did not undergo reimplantation, leaving 48 patients (31% women) who had a mean follow-up of 12.1 years. The primary outcome was treatment success per 2019 MSIS Tier 1 criteria. Kaplan-Meier analysis estimated implant survivorship; Cox regression identified predictors of failure. RESULTS Treatment success was achieved in 21 of 48 cases (39.6%). Among 27 failures, 21 underwent further infection surgery, two remained on lifelong suppressive antibiotics, and four had aseptic revision. Amputation was required in 11 patients (22.9%). The five- and 10-year implant survival for all-cause revision was 63.2 and 42.3%, respectively; for PJI-specific revision, 65.1 and 47.7%. Younger age was the only independent predictor of failure (OR [odds ratio] 0.898 per year; 95% CI [confidence interval] 0.836 to 0.965; P = 0.003). Excluding culture-negative cases, 31% had a new infecting organism at repeat revision, and polymicrobial infection increased (12.5%). CONCLUSION Repeat two-stage revision for recurrent knee PJI yields low infection control rates and major morbidity, including a 23% amputation rate. Younger patients are at greater risk of failure. These findings underscore the need for careful patient selection and exploration of alternative strategies.
