{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:10:00Z","timestamp":1779171000461,"version":"3.51.4"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Management strategies for (suspected) periprosthetic joint infection after total knee arthroplasty (TKA-PJI) include debridement, antibiotics, and implant retention (DAIR); one-stage revision; 1.5-stage revision; and two-stage revision. Reported outcomes for these four approaches vary widely across studies, with failure rates ranging from 0% to 40%. This study aims to compare the four strategies in terms of reinfection rates, microbial profiles of recurrent infections, short- and long-term infection-free prosthesis survival, re-revision rates for any cause, and long-term implant loosening-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis of 145 patients who underwent DAIR, one-stage revision, 1.5-stage revision, or two-stage revision for TKA-PJI at our centre between October 2012 and October 2022. All patients had a minimum follow-up of 2 years. Diagnosis of PJI was based on the Musculoskeletal Infection Society (MSIS) criteria for PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After a median follow-up of 99 (35, 164)months, infection recurred in 25 cases (18.8%). Of these, 7 cases (5.3%) were defined as relapses (same organism as the initial revision), 14 cases (10.5%) as new infections (different organism), and 4 cases (3.0%) had indeterminate infection type. In 5 patients DAIR successfully eradicated the reinfection. After overall follow-up 25 patients (18.8%) underwent re-revision surgery, 17 patients (12.8%) due to an infection and 8 patients (6.0%) for aseptic reasons. The cumulative reinfection rates at 2 years after DAIR, one-stage revision,1.5-stage revision, and two-stage revision was 14.6% (95% CI: 7.8% to 15.1%), 16.0% (95% CI: 9.7% to 21.2%), 13.8% (95% CI: 8.4% to 18.9%), and 4.0% (95% CI: 3.0% to 11.1%), respectively; at 5 years was 18.4% (95% CI: 9.2% to 16.4%), 20.8% (95% CI: 11.6% to 22.2%), 17.9% (95% CI: 10.0% to 19.8%), and 17.0% (95% CI: 8.1% to 14.1%), respectively. Overall, the cumulative reinfection rates at 2 and 5 years was 11.0% vs. 18.2% (\u03c72 = 2.950,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.093). The prosthesis-free infection survival rates at 2 and 5 years after DAIR, one-stage revision,1.5-stage revision, and two-stage revision were 85.4% vs. 81.6%, 84.0% vs. 79.2%, 86.2% vs. 82.1%, and 96.0% vs. 83.0%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Treatment of a (suspected) TKA-PJI by four strategies\u2014DAIR, one-stage, 1.5-stage, and two-stage revision\u2014had acceptable results based on re-revision and reinfection rates in the long-term (&amp;gt;5 years), resembling the short-term results (&amp;lt;2 years). Focussing on the cultures at the time of initial revision, the incidence of new infections during follow-up was twice that of relapses. Reinfection rates were higher in cases with positive cultures at reimplantation. Patients should be counselled appropriately in this particular situation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1769101","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:44:35Z","timestamp":1779169475000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reinfection and re-revision rates of periprosthetic knee infection under four different surgical strategies: a single centre retrospective observational study"],"prefix":"10.3389","volume":"16","author":[{"given":"Changzhi","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]},{"name":"Department of Joint Surgery and Sports Medicine, Ningde Municipal Hospital","place":["Ningde, Fujian, China"]},{"name":"Ningde Clinical Medical College of Fujian Medical 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