To evaluate the clinical outcomes of patients with chronic Periprosthetic Joint Infection (PJI) who survived with spacer and those who underwent two-stage revision.

The data of patients with chronic PJI treated in our center from 2014 to 2022 were retrospectively collected. According to the final treatment plan, the patients were divided into Destination Joint Spacers (DJS) and Two-Stage Revision (TSR). DJS group was divided into Cement spacer (CS) and Prosthetic spacer (PS) according to the different types of implanted spacer. The patient's age, gender, body mass index, laboratory test results, preoperative and postoperative joint function scores, and visual analogue scale (VAS) of pain were recorded. The infection control rate and complication rate were compared between the DJS group and the TSR group.

A total of 98 patients with chronic PJI were enrolled, with an average age of 65.14±9.88 years (range, 32-88 years). There were 35 patients in the DJS group and 63 patients in the TSR group. All patients were followed up for at least 1 year (mean 52.68±26.07 months). In terms of infection control rate, there were 5 cases (14.28%) of recurrent infection in the DJS group and 6 cases (9.52%) in the TSR group. There was no significant difference in infection control rate between the two groups (P=0.474). In terms of function, the postoperative joint function score of the TSR group was higher than that of the DJS group. However, there was no significant difference in functional satisfaction of the affected limb between the patients in the DJS group (65.71%) and TSR group (66.67%) during follow-up (P=0.924). In terms of complications, there were 2 cases of prosthesis fracture, 4 cases of joint dislocation, 2 cases of periprosthetic joint fracture, and 2 cases of deep vein thrombosis in DJS group. There were 2 cases of periprosthetic fracture, 2 cases of dislocation and 2 cases of deep vein thrombosis in the TSR group. The incidence of complications in the DJS group was higher than that in the TSR group (P=0.015). In the DJS group, the PS group had a significantly lower incidence of complications than the CS group (P=0.009), and there was no significant difference between the PS group and the TSR group (P=0.388).

DJS group and TSR group have similar infection control rates and functional outcomes. When patients cannot tolerate or are unwilling to undergo two-stage revision, survival with spacer, especially prosthetic spacer, can be the final treatment option for some patients with chronic PJI.