The Joint EBJIS-MSIS 2026 Conference

Time to Reimplantation: Waiting Longer May Increase the Risk of Subsequent Failure

M. Lane Moore, MD, MBA; Collin L. Braithwaite, MD; Saad Tarabichi, MD; Jens T. Verhey, MD; Zachary K. Christopher, MD; David G. Deckey, MD; Henry D. Clarke, MD; Mark J. Spangehl, MD; Joshua S. Bingham, MD

BACKGROUND

•Two-stage exchange arthroplasty remains an important treatment strategy for chronic periprosthetic joint infection (PJI). Following resection arthroplasty and antibiotic spacer placement, surgeons must determine the appropriate timing of definitive reimplantation.

•The optimal interstage interval remains uncertain. While delaying reimplantation may allow additional time for antimicrobial treatment, prolonged spacer retention extends functional impairment and may increase morbidity.

•Whether longer intervals improve infection eradication or adversely affect outcomes remains unclear.

•Purpose: To evaluate the association between time to reimplantation and treatment failure following two-stage exchange for chronic knee PJI.

METHODS

Retrospective review of 576 patients undergoing two-stage exchange for chronic knee PJI.

PJI defined using 2013 MSIS criteria.

Excluded reimplantation >180 days (n=76) and spacer exchange (n=49).

Final cohort: 451 patients; mean follow-up 5.8 ± 3.6 years.

Failure was defined as reoperation for infection or PJI-related mortality.

Interstage duration was analyzed per 10-day increase and by intervals of <76, 76–100, and ≥100 days.

Multivariable regression identified independent predictors of failure.

RESULTS

Among 451 patients, 71 (15.7%) experienced treatment failure and 380 (84.3%) experienced success. Baseline health status and infecting organisms did not differ between timing groups (all p>0.05).

Every additional 10 days increased the adjusted odds of failure by 22%

Adjusted OR 1.219 (95% CI 1.072–1.370); p=0.001

Reimplantation at ≥100 days was associated with approximately 3-fold greater odds of failure, while reimplantation at <76 days was associated with treatment success.

Active smoking was also independently associated with failure (OR 10.20; 95% CI 2.398–46.47; p=0.002).

CONCLUSION

•Longer time to reimplantation was independently associated with greater treatment failure following two-stage exchange for chronic knee PJI.

•Every additional 10 days increased the adjusted odds of failure by 22%. Reimplantation within <76 days was associated with lower odds of failure.

•These findings suggest that unnecessary delays in reimplantation may be detrimental and that prolonged spacer retention should not be pursued solely to extend the interstage interval.

The Joint EBJIS-MSIS 2026 Conference

Time to Reimplantation: Waiting Longer May Increase the Risk of Subsequent Failure

Poster Presenter

Authors

Affiliations

Part of Topic