{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:21:17Z","timestamp":1784805677383,"version":"3.55.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004869","name":"Westf\u00e4lische Wilhelms-Universit\u00e4t M\u00fcnster","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004869","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34\u00a0months (IQR 22\u201351). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan\u2013Meier survival curves and comparative non-parametric testing.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>78% (43\/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16\/43) underwent additional revision for infection and 14% (6\/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64\u201389%) after 1\u00a0year and 38% (95% CI 18\u201357%) after 5\u00a0years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, <jats:italic>p<\/jats:italic>\u2009=\u20090.034). Furthermore, obese patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.026, Fisher\u2019s exact test) and diabetics (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15\/55) and at re-reinfection (32%, 9\/28). Pathogen persistence was observed in 21% (6\/28) of re-reinfected patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-021-04330-z","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T06:03:29Z","timestamp":1641276209000},"page":"1731-1740","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?"],"prefix":"10.1007","volume":"143","author":[{"given":"A. 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