Dual Surgical Setup Associated with Reduced Infection Recurrence for Hip and Knee Arthroplasty After Two-Stage Exchange

J Am Acad Orthop Surg. 2024 Jan 15;32(2):68-74. doi: 10.5435/JAAOS-D-23-00317. Epub 2023 Oct 3.


Introduction: Two-stage exchange (TSE) is the gold standard for the treatment of chronic periprosthetic joint infection (PJI) after total joint arthroplasty of the hip and knee in the United States. Failure of treatment can have devastating consequences for the patient, including poor functional outcomes, multiple further surgeries, and increased mortality. Several factors associated with infection recurrence have previously been identified in the literature. The purpose of this study was to evaluate whether the use of a dual surgical setup was associated with reduced risk of recurrence after TSE for PJI.

Methods: A retrospective study was conducted between January 2000 and December 2021 to isolate patients who underwent TSE after total joint arthroplasty of the hip and knee. Failure was defined as infection recurrence requiring surgical intervention. Demographic factors (age, sex, body mass index, smoking status, American Society of Anesthesiologists status), preoperative comorbidities (hypertension, cardiac disease, diabetes status, depression diagnosis, pulmonary disease), operating surgeon, single versus dual setup, hospital setting, use of long-term antibiotics postoperatively after TSE, aspiration data, and infecting organism were compared between cohorts using multivariate regression analysis.

Results: A total of 134 patients were identified who underwent TSE after diagnosis of PJI. The mean follow-up was 67.84 (range, 13 to 236) months. Dual setup (odds ratio, 0.13; confidence interval, 0.02 to 0.52; P = 0.0122) was found to be an independent predictive variable associated with a lower risk of infection recurrence.

Conclusion: Utilization of a dual surgical setup is a low-cost modifiable risk factor associated with a lower risk of recurrence of after TSE of the hip and knee for PJI.

MeSH terms

  • Arthritis, Infectious* / etiology
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Humans
  • Knee Joint / surgery
  • Prosthesis-Related Infections* / diagnosis
  • Prosthesis-Related Infections* / etiology
  • Prosthesis-Related Infections* / prevention & control
  • Reoperation / adverse effects
  • Retrospective Studies
  • Risk Factors