CORR Insights®: Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

“…Recent studies have shown that septic failure after two-stage revisions is mainly due to new infection and not persistent infection (22). This could explain why other tests, such as histopathology and inflammatory markers, lack sensitivity to detect subsequent infections during the secondstage surgery (22,23). These reinfections might be not due to persistent infection harbored on the spacer but to a host predisposition to infection, which could be the reason we observed an association between previous surgical procedures involving the same joint and subsequent septic failure.…”

Recurrent Failures After 2-Stage Exchanges are Secondary to New Organisms Not Previously Covered by Antibiotics

“…Failure following 2-stage revisions are thought to be due to either a recurrent reinfection due to failed treatment of the initial organism or a new infection due to a different pathogen [ 21 ]. Recent studies have reported that the majority of failures secondary to infection are due to organisms different than the ones originally identified, suggesting that most failures are due to a new infection [ 3 ].…”

“…However, these studies failed to evaluate the antibiotic sensitivities of the organisms associated with these failures. As a result, a third etiology, that the “new” organism was present during the initial infection but not detected (and thus not treated by the antibiotics given), cannot be ruled out [ 21 ]. The purpose of this study was to determine if reinfections following 2-stage revisions for PJI were due to the same or a new organism, and if the latter, whether these organisms were susceptible to the antibiotics originally administered.…”