Very late periprosthetic joint infection: Etiological agents and outcomes of two stage revision

The main aim of the current study is to evaluate the success of two-stage revision surgery in very late periprosthetic joint infection (PJI). The second aim was to identify the causative etiological agents and to rank these pathogens according to their incidence. Twenty-seven patients (16 THA and 11 TKA) who were operated on with two-stage revision arthroplasty due to very late PJI (>60 months after primary arthroplasty) were included in our study. Demographic information of the patients, operation site, follow-up period, time from the first spacer application to the second stage revision, number of spacer replacement surgeries, duration of infection, presence of fistula, presence of recurrence after second stage arthroplasty and complications were noted. Preoperative and last follow-up Knee Society and Harris Hip Scores were calculated. The success of two-stage revision surgery was evaluated statistically. The causative etiological agents were ranked according to their incidence. The age of the patients at the time of first stage revision ranged from 24 to 94 years, with a mean age of 57.9±15.7. Infection recurrence was 18.75% in the very late hip and 27.3% in the very late knee PJI group. There was a statistically significant increase in postoperative Knee Society and Harris Hip Scores (p<0.05). Staphylococcus epidermidis was the first and Staphylococcus aureus was the second in the ranking of isolated pathogens according to their frequency (37% and 18.5%, in total, respectively). There were 2 patients infected with Pseudomonas aeruginosa in the very late hip and one patient infected with Escherichia Coli in the very late knee PJI group. Two-stage revision is an effective and safe surgical procedure to treat PJI and achieve better functional outcomes. Staphylococcus epidermidis was the pathogen with the highest incidence, while Staphylococcus aureus was the pathogen with the second highest incidence in very late PJI.