JOA - 2026-06-01 - Journal Article
Lower Reported Success Rates of Two-Stage Revisions for Periprosthetic Joint Infections Using Musculoskeletal Infection Society Outcome Reporting Tool at a Specialty Referral Center.
Tubin N, Bonello JP, Abdelbary H, Grammatopoulos G, Beaulé PE, Garceau S
Topics
Key Takeaway
Using MSIS Outcome Reporting Tool criteria, two-stage revision THA PJI success was only 58.2% at a tertiary referral center, versus 86.6% when the less stringent Delphi criteria were applied to the same cohort.
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Summary
This study evaluated two-stage revision outcomes for THA PJI at a single tertiary referral center over 13 years using two distinct outcome reporting frameworks. Of 67 consecutive patients with minimum 2-year follow-up, MSIS Tier 1+2 success was 58.2% versus 86.6% by Delphi criteria; 18 patients (26.9%) retained spacers permanently and were classified as Tier 3F failures under MSIS but contributed to the higher Delphi success rate. Chronic antibiotic suppression was required in 29.9% of patients, and 23.9% had undergone prior PJI surgery before index two-stage revision.
Key Limitation
The referral-center case mix—with 23.9% of patients having prior PJI surgery—introduces selection bias that precludes generalization of these success rates to community or lower-complexity THA PJI populations.
Original Abstract
BACKGROUND
The gold standard treatment for total hip arthroplasty (THA) periprosthetic joint infection (PJI) is a two-stage revision. Reported success rates are greater than 80%; however, significant differences remain in how treatment success rates are defined. The purpose of this study was to evaluate our specialized, tertiary hospital's experience with planned two-stage revisions for complex THA PJI.
METHODS
Consecutive patients who underwent a planned two-stage revision for THA PJI at our institution over a 13-year period were assessed. Patients had a minimum 2-year follow-up, and those who had unplanned spacer retention were included. The primary outcome was treatment success defined by the Delphi Criteria and Musculoskeletal Infection Society Outcome Reporting Tool (Tiers 1 and 2). Failure for reimplantation (Tier 3F) was recorded. Baseline characteristics were collected. Factors associated with treatment outcome were analyzed. A total of 67 patients were identified at a mean follow-up of 8.6 years (range, 2.5 to 15.0). There were 16 patients who underwent previous surgeries for their PJI (23.9%).
RESULTS
Utilizing the Musculoskeletal Infection Society Outcome Reporting Tool criteria, treatment success was achieved in 39 patients (58.2%) with reimplantation (Tier 1: 37 [55.2%], Tier 2: two [3%]). In contrast, an 86.6% success rate was noted when utilizing the Delphi criteria. Eighteen patients did not proceed with reimplantation and retained their spacers (Tier 3F). There were three patients (4.5%) who died during PJI treatment and 20 patients (29.9%) who were placed on chronic antibiotic suppression. Considering infection control with and without reimplantation, overall treatment success was achieved in 57 patients (85.1%).
CONCLUSIONS
Our study suggests that two-stage revisions at specialized PJI referral centers may be less successful than previously reported and highlights discrepancies between reporting measures. As PJI care moves toward specialized PJI centers, where spacer retention may be more prevalent, there is a need for consistent and transparent reporting of outcomes when treating complex cases.