Toggle Main Menu Toggle Search

Open Access padlockePrints

Change in organism between first- and second-stage revision for periprosthetic joint infection of knee arthroplasty independently associated with increased risk of failure: A two-centre study

Lookup NU author(s): Professor David Deehan



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2023, British Editorial Society of Bone and Joint Surgery. All rights reserved. Aims: Achievement of accurate microbiological diagnosis prior to revision is key to reducing the high rates of persistent infection after revision knee surgery. The effect of change in the microorganism between the first-and second-stage revision of total knee arthroplasty for periprosthetic joint infection (PJI) on the success of management is not clear. Methods: A two-centre retrospective cohort study was conducted to review the outcome of patients who have undergone two-stage revision for treatment of knee arthroplasty PJI, focusing specifically on isolated micro-organisms at both the first-and second-stage procedure. Patient demographics, medical, and orthopaedic history data, including postoperative outcomes and subsequent treatment, were obtained from the electronic records and medical notes. Results: The study cohort consisted of 84 patients, of whom 59.5% (n = 50) had successful eradication of their infection at a mean follow-up of 4.7 years. For the 34 patients who had recurrence of infection, 58.8% (n = 20) had a change in isolated organism, compared to 18% (n = 9) in the infection eradication group (p < 0.001). When adjusting for confound, there was no association when the growth on the second stage was the same as the first (odd ratio (OR) 2.50, 95% confidence interval (CI) 0.49 to 12.50; p = 0.269); however, when a different organism was identified at the second stage, this was independently associated with failure of treatment (OR 8.40, 95% CI 2.91 to 24.39; p < 0.001). There were no other significant differences between the two cohorts with regard to patient demographics or type of organisms isolated. Conclusion: Change in the identified microorganism between first-and second-stage revision for PJI was associated with failure of management. Identification of this change in the microorganism prior to commencement of the second stage may help target antibiotic management and could improve the success of surgery in these patients.

Publication metadata

Author(s): Walker LC, Clement ND, Yapp LZ, Deehan DJ

Publication type: Article

Publication status: Published

Journal: Bone and Joint Open

Year: 2023

Volume: 4

Issue: 9

Pages: 720-727

Online publication date: 21/09/2023

Acceptance date: 02/04/2018

Date deposited: 09/10/2023

ISSN (electronic): 2633-1462

Publisher: British Editorial Society of Bone and Joint Surgery


DOI: 10.1302/2633-1462.49.BJO-2023-0067.R1


Altmetrics provided by Altmetric