Two-stage exchange arthroplasty is considered the gold standard treatment for chronic periprosthetic joint infection (PJI). However, there is a scarcity of research investigating the major risk factors for infection recurrence and the prognosis after infection recurrence. This study included 203 patients who underwent 2-stage exchange arthroplasty between June 22, 2010 and January 24, 2017. The need of reoperation for infection-related or PJI-related mortality was considered treatment failure. Participant age, gender, body mass index, comorbidities, culture results, length of hospital stay, cause of treatment failure, operative procedure, and fate were analyzed. Fifty-three patients experienced treatment failure (26.1%). Mean follow-up was 63 months (range, 26-103). Based on the multivariate analyses, risk factors for treatment failure included men and positive intraoperative culture during reimplantation. Recurrent infection was most commonly caused by (32.1%, 17/53), and new microorganisms caused recurrent infection in 34 of 53 (64.2%) patients. In 44 patients who had treatment failure, debridement, antibiotic therapy, irrigation, and retention of prosthesis (DAIR) performed within 6 months of reimplantation and at <3 weeks from symptom onset resulted in a significantly higher success rate than the use of other DAIR protocols ( = .031). Men and positive intraoperative culture are major risk factors for 2-stage exchange arthroplasty failure in patients who have knee PJI. Recurrent infection in these patients is usually caused by new microorganisms. DAIR within 6 months of reimplantation and at <3 weeks from symptom onset results in good outcomes in these patients.

中文翻译：

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膝关节假体周围感染二期置换术治疗失败的危险因素及其命运

两阶段置换关节置换术被认为是治疗慢性假体周围感染（PJI）的金标准。然而，目前缺乏对感染复发的主要危险因素以及感染复发后预后的研究。这项研究纳入了 203 名在 2010 年 6 月 22 日至 2017 年 1 月 24 日期间接受两阶段置换关节置换术的患者。因感染相关或 PJI 相关死亡而需要再次手术被视为治疗失败。分析参与者的年龄、性别、体重指数、合并症、培养结果、住院时间、治疗失败原因、手术过程和命运。 53 名患者经历了治疗失败（26.1%）。平均随访时间为 63 个月（范围 26-103）。根据多变量分析，治疗失败的危险因素包括男性和再植期间术中培养阳性。反复感染最常见的原因是（32.1%，17/53），53 名患者中有 34 名（64.2%）新微生物引起反复感染。在 44 名治疗失败的患者中，在再植入后 6 个月内以及症状出现后 3 周内进行清创、抗生素治疗、冲洗和保留假体 (DAIR) 的成功率显着高于使用其他 DAIR 方案(=.031)。男性和术中培养阳性是膝关节 PJI 患者二期置换术失败的主要危险因素。这些患者的反复感染通常是由新微生物引起的。再植入后 6 个月内和症状出现后 3 周内进行 DAIR 可为这些患者带来良好的预后。