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2025 · Knee Surgery & Related Research

What Are the Risk Factors for PJI Recurrence after Two-stage Reimplantation?

Infection recurred in 15/65 patients (23.1%). Median time to recurrence was 11 months (range 4–108 months).

Fig. 4 is the original.

Infection-free survival after two-stage revision, stratified by organism.Enlarge Figure

Infection-free survival after two-stage revision, stratified by organism.

Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro. Risk factors of recurrent periprosthetic joint infection of the knee after two-stage reimplantation. Knee Surgery & Related Research (2025). DOI: 10.1186/s43019-025-00258-5. © The Author(s) 2025

Evidence & Original SourceImage use terms
Original Figure Legend

PJI relapse survival curve of the patients according to the type of pathogen that caused the initial PJI; comparison between …

Participants and Methods

65 knees; mean follow-up, 4.8 years. A retrospective cohort analysis used a Cox proportional hazards model.

The order in which you read the painting.

Recurrence-free survival curves are stratified by the organisms identified in the initial infection. They concern recurrence after two-stage revision, rather than the infection incidence of primary TKA. Risk factors were analyzed from 15 recurrences in 65 knees. Twenty years of retrospective data and few events make uncertainty especially important for large hazard ratios. Revision status, polymicrobial infection, and ESR associations can inform surveillance, but cannot determine whether an individual will have recurrence.

Main Findings

Infection recurred in 15/65 patients (23.1%), at a median 11 months (range 4–108). HRs for revision TKA at initial infection, multiple organisms and higher ESR were 40.29, 1.53 and 1.03 (P < 0.001, P = 0.04 and P = 0.009).

The point of reading on surgery

The findings may inform risk stratification during follow-up after revision for infection and guide further research.

Limitations

The sample was small, with 15 recurrence events. HR 40.29 should not be extrapolated as a stable risk multiplier for the general population. This was not a randomized trial of treatment strategies.

Let's put it briefly.

What did this study confirm?

Infection recurred in 15/65 patients (23.1%). Median time to recurrence was 11 months (range 4–108 months).

Can it be applied directly to individual patients' treatment decisions?

The sample was small, with 15 recurrence events. HR 40.29 should not be extrapolated as a stable risk multiplier for the general population. This was not a randomized trial of treatment strategies.

Keywords

Abstract · Original text

Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro. Risk factors of recurrent periprosthetic joint infection of the knee after two-stage reimplantation. Knee surgery & related research. 2025;37(1):4. doi:10.1186/s43019-025-00258-5.

INTRODUCTION

Prosthetic joint infection (PJI) is one of the most common and detrimental complications of total knee replacement arthroplasty (TKA). Despite extensive efforts, including two-stage reimplantation, to eradicate PJI, it still recurs in a substantial number of patients. However, the risk factors of recurrence after two-stage reimplantation of the knee have not been established. In this study, it is hypothesized that there will be certain risk factors of recurrence after two-stage reimplantation for PJI of the knee.

MATERIALS AND METHODS

From March 2002 to December 2022, 65 knees that underwent two-stage reimplantation for PJIs in a single, tertiary hospital were retrospectively reviewed, and 44 patient-related, laboratory-related, and surgery-related factors, including body mass index, pathogen type, and the usage of transfusions, were selected as the potential risk factors for recurrence. Survival analysis using the Kaplan-Meier method and subsequent Cox proportional hazard regression were performed.

RESULTS

Out of the 65 knees that underwent two-stage reimplantation, infection recurred in 15 knees (23.1%) in a median 11 (range 4-108) months. The Cox proportional hazards regression showed that infection of revision TKA, mixed pathogen-type infection, and higher serum erythrocyte sedimentation rate (ESR, mm/h) level increases the risk of recurrence (p-values < 0.001, 0.04, and 0.009; hazard ratios 40.29, 1.53, and 1.03, respectively).

CONCLUSIONS

A significant portion of PJI of the knees recurred after two-stage reimplantation. Revision TKA at the time of initial PJI, mixed pathogen-type infection, and higher serum ESR level were three significant risk factors of PJI recurrence. Surgeons should be more cautious in suspecting PJI relapse for these specific occasions.

LEVEL OF EVIDENCE

III, retrospective cohort study.

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© The Author(s) 2025

The original paper.

Risk factors of recurrent periprosthetic joint infection of the knee after two-stage reimplantation

Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro
Knee Surgery & Related Research · 2025

DOI · 10.1186/s43019-025-00258-5PubMedBased data
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