Periprosthetic total joint infections: staging, treatment, and outcomes.

Forty-three patients having 49 treatment protocols for periprosthetic total joint infections were staged prospectively, using an osteomyelitis classification system designed to stratify treatment selection according to patient risk factors. Implant salvage was possible in 66% of the infections treated within 30 days of the surgical procedure or within 14 days of symptom onset after a late, septic event. After debridement and implant removal, 88% of the patients with long-standing, refractory infections now have infection-free, functional reconstructions; 64% of these patients have a new, total joint replacement at the original site of treatment. All of the treatment failures, deaths, and amputations occurred in the high-risk patient cohorts prospectively identified within the staging system. Infection duration and the condition of the host are the two most important variables in predicting outcomes in patients with periprosthetic infections.