Treatment of joint prosthesis infection in accordance with current recommendations improves outcome

Clin Infect Dis. 2008 Apr 15;46(8):1221-6. doi: 10.1086/529436.


Background: Recently recommended treatment modalities for prosthetic joint infection (PJI) were evaluated.

Methods: A retrospective cohort analysis of 68 patients with PJI of hip or knee who were treated from 1995 through 2004 was conducted at the University Hospital Bern (Bern, Switzerland).

Results: A 2-stage exchange was the most frequent (75.0%) surgical strategy, followed by retention and debridement (17.6%), 1-stage exchange (5.9%), and resection arthroplasty or suppressive antimicrobial treatment (1.5%). The chosen strategy was in 88% agreement with the recommendations. Adherence was only 17% for retention and debridement and was 0% for 1-stage exchange. Most PJIs (84%) were treated with an adequate or partially adequate antimicrobial regimen. Recurrence-free survival was observed in 51.5% of PJI episodes after 24 months of follow-up. The risk of treatment failure was significantly higher for PJI treated with a surgical strategy other than that recommended (hazard ratio, 2.34; 95% confidence interval, 1.10-4.70; P = .01) and for PJIs treated with antibiotics not corresponding to recommendations (hazard ratio, 3.45; confidence interval, 1.50-7.60; P = .002). Other risk factors associated with lack of healing were a high infection score at the time of diagnosis (hazard ratio, 1.29; 95% confidence interval, 1.10-1.40; P < .001) and presence of a sinus tract (hazard ratio, 2.35; 95% confidence interval, 1.10-5.0; P = .02).

Conclusions: Our study demonstrates the value of current treatment recommendations. Inappropriate choice of conservative surgical strategies (such as debridement and retention) and inadequate antibiotic treatment are associated with failure.

MeSH terms

  • Aged
  • Anti-Infective Agents / therapeutic use
  • Arthroplasty, Replacement / methods*
  • Cohort Studies
  • Female
  • Hip Prosthesis / microbiology
  • Humans
  • Joint Prosthesis / microbiology*
  • Knee Prosthesis / microbiology
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / therapy*
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome


  • Anti-Infective Agents