Component-specific prognostic signals within a multidimensional classification for periprosthetic joint infection and the impact of repeated surgical episodes: a retrospective cohort study
- 1Department of Orthopaedic Surgery Kobe University Graduate School of Medicine
Abstract
Background: The PJI-TNM classification provides a multidimensional description of periprosthetic joint infection, but the prognostic contribution of its individual components remains uncertain. Objective: To evaluate component-specific associations with infection-related reoperation and determine how repeated surgical episodes within patients influence risk estimates. Methods: We retrospectively analysed 116 hip or knee periprosthetic joint infection surgical episodes in 84 patients treated from April 2016 to February 2026. The outcome was the first unplanned infection-related reoperation after each index operation. Kaplan-Meier and Cox analyses were performed, using patient-clustered robust variance estimates to account for repeated episodes. A patient-level sensitivity analysis used the first observed episode per patient. Results: Infection-related reoperation occurred after 42 episodes. Reoperation-free survival was 70.8% at 180 days, 63.1% at 1 year, and 55.1% at 2 years. In the primary clustered model, T2 showed an elevated but imprecise hazard estimate (hazard ratio 2.61, 95% confidence interval 0.89-7.72), whereas T1 did not. The N component showed no clear association with outcome. M2 produced a high estimate but comprised only three episodes from two patients. In the patient-level sensitivity analysis, the T2 hazard ratio was 4.78 (95% confidence interval 1.05-21.81). Conclusion: Prognostic information within PJI-TNM was unevenly distributed across components. Severe soft-tissue compromise represented by T2 showed the most consistent adverse signal, while repeated-episode analyses materially affected precision. Multicentre validation is required.
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BibTeX
@article{kumabe2026componentspecific,
title = {{Component-specific prognostic signals within a multidimensional classification for periprosthetic joint infection and the impact of repeated surgical episodes: a retrospective cohort study}},
author = {Yohei Kumabe and Kenichi Sawauchi and Yutaka Matsumiya and Tomoaki Fukui and Shinya Hayashi and Tomoyuki Matsumoto and Ryosuke Kuroda and Keisuke Oe},
journal = {Orthopedic Reviews},
year = {2026},
month = oct,
doi = {10.52965/001c.172841},
url = {https://doi.org/10.52965/001c.172841},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Component-specific prognostic signals within a multidimensional classification for periprosthetic joint infection and the impact of repeated surgical episodes: a retrospective cohort study
AU - Yohei Kumabe
AU - Kenichi Sawauchi
AU - Yutaka Matsumiya
AU - Tomoaki Fukui
AU - Shinya Hayashi
AU - Tomoyuki Matsumoto
AU - Ryosuke Kuroda
AU - Keisuke Oe
PY - 2026
DA - 2026/10/30
JO - Orthopedic Reviews
DO - 10.52965/001c.172841
UR - https://doi.org/10.52965/001c.172841
AB - Background: The PJI-TNM classification provides a multidimensional description of periprosthetic joint infection, but the prognostic contribution of its individual components remains uncertain. Objective: To evaluate component-specific associations with infection-related reoperation and determine how repeated surgical episodes within patients influence risk estimates. Methods: We retrospectively analysed 116 hip or knee periprosthetic joint infection surgical episodes in 84 patients treated from April 2016 to February 2026. The outcome was the first unplanned infection-related reoperation after each index operation. Kaplan-Meier and Cox analyses were performed, using patient-clustered robust variance estimates to account for repeated episodes. A patient-level sensitivity analysis used the first observed episode per patient. Results: Infection-related reoperation occurred after 42 episodes. Reoperation-free survival was 70.8% at 180 days, 63.1% at 1 year, and 55.1% at 2 years. In the primary clustered model, T2 showed an elevated but imprecise hazard estimate (hazard ratio 2.61, 95% confidence interval 0.89-7.72), whereas T1 did not. The N component showed no clear association with outcome. M2 produced a high estimate but comprised only three episodes from two patients. In the patient-level sensitivity analysis, the T2 hazard ratio was 4.78 (95% confidence interval 1.05-21.81). Conclusion: Prognostic information within PJI-TNM was unevenly distributed across components. Severe soft-tissue compromise represented by T2 showed the most consistent adverse signal, while repeated-episode analyses materially affected precision. Multicentre validation is required.
SN - 2035-8237
SN - 2035-8164
ER -