Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2019; 10(10): 348-355
Published online Oct 18, 2019. doi: 10.5312/wjo.v10.i10.348
Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee
Ewout S Veltman, Dirk Jan F Moojen, Marc L van Ogtrop, Rudolf W Poolman
Ewout S Veltman, Dirk Jan F Moojen, Rudolf W Poolman, Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
Ewout S Veltman, Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden 2333ZA, Netherlands
Marc L van Ogtrop, Department of Medical Microbiology, OLVG, Amsterdam 1091AC, Netherlands
Author contributions: Veltman ES, Moojen DJF, van Ogtrop ML, and Poolman RW designed the study; Veltman ES performed extraction, synthesis, and interpretation of data; Veltman ES, Moojen DJF, van Ogtrop ML, and Poolman RW drafted and/or revised the manuscript.
Informed consent statement: This study was exempt from acquiring written informed consent by the OLVG medical ethics committee, with study number 15.080.
Conflict-of-interest statement: All authors have no conflicts of interest related to the manuscript.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ewout S Veltman, MD, Doctor, Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Oosterpark 9, Amsterdam 1091AC, Netherlands.
Telephone: +31-20-5108884
Received: May 20, 2019
Peer-review started: May 20, 2019
First decision: July 31, 2019
Revised: August 14, 2019
Accepted: September 4, 2019
Article in press: September 4, 2019
Published online: October 18, 2019

Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.


To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.


All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up.


Forty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients.


PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved.

Keywords: Periprosthetic joint infection, Two-stage revision, Knee arthroplasty, Hip arthroplasty, Coagulase-negative Staphylococcus

Core tip: Periprosthetic joint infections of the hip and knee caused by coagulase-negative Staphylococci can be difficult to treat. We retrospectively reviewed all patients treated with two-stage revision arthroplasty for such an infection in our hospital between 2003 and 2016. We treated 44 patients with coagulase-negative Staphylococci infection of the hip or knee with a two-stage revision using an antibiotic-loaded spacer. At final follow-up, infection was eradicated in 33 of these patients.