Reinfection and Re-revision Rates of Periprosthetic Knee Infection Under Four Different Surgical Strategies

Reinfection and Re-revision Rates of Periprosthetic Knee Infection Under Four Different Surgical Strategies: a Single Centre Retrospective Observational Study

A single-center retrospective cohort study was conducted in the Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University. This study reviewed 145 patients who underwent debridement, antibiotics, and implant retention (DAIR), 1-stage revision, 1.5-stage revision, and 2-stage revision surgeries for total knee arthroplasty periprosthetic joint infection (TKA-PJI) at this institution between 2012 and 2022. The differences in postoperative reinfection rate, microbial composition of reinfection, short-term and long-term aseptic prosthesis survival rate, prosthesis loosening and revision rate due to any cause, and long-term loosening-free survival rate among the four revision surgical approaches for TKA-PJI were evaluated, so as to provide reference value for clinical decision-making.

Study Overview

• Status: Completed
• Conditions: Reinfection; Periprosthetic Joint Infection (PJI); Total Knee Arthroplasty; Revision; Aseptic Loosening

Detailed Description

A single-center retrospective cohort study was conducted in the Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University. This study reviewed 145 patients who underwent debridement, antibiotics, and implant retention (DAIR), 1-stage revision, 1.5-stage revision, and 2-stage revision surgeries for total knee arthroplasty periprosthetic joint infection (TKA-PJI) at this institution between 2012 and 2022. In this study, we aimed to evaluate: (1) the postoperative reinfection rates following four surgical strategies for TKA-PJI; (2) the microbial profile of recurrent infections; (3) short- and long-term infection-free implant survival rates across the four surgical approaches; (4) re-revision rates due to aseptic loosening and long-term aseptic loosening-free implant survival rates; and (5) the reinfection rate in patients with positive cultures at the time of reimplantation. In order to provide reference value for clinical decision-making.

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• China
  • Fujian
    • Fuzhou, Fujian, China, 350005
      • The First Affiliated Hospital of Fujian Medical University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

According to the inclusion criteria, 145 patients who underwent DAIR, phase 1 revision, phase 1.5 revision, and phase 2 revision surgery for TKA-PJI at the institution between 2012 and 2022 were selected. All patients have completed at least 2 years of follow-up. Follow up includes prosthesis loosening, infection recurrence rate, infection recurrence rate, infection new incidence rate, bacterial positive culture rate, infection free survival rate, and revision rate for any reason.

Sampling Method

Description

Inclusion Criteria

1. Patients who met the diagnostic criteria for TKA-PJI;
2. Patients who underwent one of the following surgical interventions: DAIR, one-stage revision, 1.5-stage revision, or two-stage revision;
3. Patients with complete medical records available;
4. Patients who provided informed consent to participate in the study.

Exclusion Criteria:

1. Incomplete medical records;
2. Poor follow-up compliance, including inability to complete scheduled follow-up visits or refusal to participate in follow-up;
3. Follow-up duration less than 2 years.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
DAIR group; DAIR revision involves washout, thorough debridement, antibiotics, and all components of implant retention, but polyethylene exchange
1-stage revision group; One-stage revision involves open debridement of the infected knee, followed by immediate revision by removal and or reimplantation of all components
1.5-stage revision group; The 1.5-stage revision involves the use of a functional, articulating antibiotic-loaded knee spacer intended for long-term retention-either indefinitely or until loosening necessitates definitive TKA revision. We standardize the terminology for this procedure as "1.5-stage revision", as it represents an intermediate strategy between one-stage and two-stage revision for the treatment of PJI following TKA
2-stage revision group; Two-stage revision, with removal of implants, placement of an antibiotic spacer, and parenteral antibiotic treatment followed by TKA reimplantation has been proposed as the "gold standard" for chronic PJI treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Re-revision rate	Re-revisions with implant exchange	5 year after surgery
Reinfection rate	Reinfection rate	2 and 5 year after surgery
Infection-free survival rate	Infection-free survival rate	2 and 5 year after surgery
All-cause revision rates	All-cause revision rates	5 year after surgery

Collaborators and Investigators

• Sponsor: First Affiliated Hospital of Fujian Medical University
• Investigators: Study Director: Liu Zhang, First Affiliated Hospital of Fujian Medical University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): December 31, 2024
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: September 27, 2025
• First Submitted That Met QC Criteria: November 14, 2025
• First Posted (Actual): November 18, 2025

Study Record Updates

• Last Update Posted (Actual): November 18, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Reinfection; Total Knee Arthroplasty; Revision; Aseptic Loosening; Periprosthetic joint infection (PJI)
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Recurrence; Pathological Conditions, Signs and Symptoms; Reinfection
• Other Study ID Numbers: MTCA,ECFAH of FMU[2019]296

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No