In the United States, two-stage exchange arthroplasty remains the therapeutic gold standard for treating chronic periprosthetic joint infection (PJI). Despite the historical success of this staged approach, clinical failure remains a persistent challenge, with reinfection incidence climbing up to 10% within the first year and hitting 17% at long-term follow-up. Proceeding to the final stage demands an exceptionally accurate assessment of absolute infection clearance.
Unfortunately, diagnosing persistent or recurrent infection in a patient with an antibiotic spacer is notoriously difficult, as baseline inflammatory responses remain structurally elevated compared to primary joint arthroplasty. To navigate this, historical dogma and international consensus statements have widely popularized a reliance on a downward trend toward normalization in serum markers before clearing a patient for surgery. We set out to investigate whether these popular percentage-change trends hold any statistical validity when compared directly against rigid, absolute numerical thresholds.
