Jonathan Guntin - Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA
Joseph Serino - Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA
David Rossi - Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA
Anthony Boniello - Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA
Charles Gusho - Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA
Craig Della Valle - Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA

Objectives: This study aimed to evaluate the effect of hypoalbuminemia on failure rates and mortality after a two-stage revision for PJI.Methods: ۱۹۹ Patients (۱۳۰ knees and ۶۹ hips) with a mean age of ۶۴.۷ ± ۱۰.۷ years who underwent a two-stage exchange were retrospectively reviewed at a mean of ۵۱.۲ ± ۳۹.۷ months. Failure of treatment was defined as any revision within the follow-up period, failure to undergo reimplantation, or death within one year of initiating treatment.Results: There were ۷۱ failures (۳۵.۷%), including ۳۸ septic failures (۱۹.۱%). We found no differences between successful revisions and failures regarding hypoalbuminemia (۴۳% vs. ۴۲% prior to stage ۱, P=۱ and ۳۲% vs. ۲۹% prior to stage ۲, P=۰.۸۵۶). There were also no differences in hypoalbuminemia rates between septic failures and the rest of the cohort (۴۲% vs. ۴۳% prior to stage ۱, P=۱.۰ and ۳۴% vs. ۳۰% prior to stage ۲, P=۰.۶۷۴). Hypoalbuminemia prior to stage ۲ was a significant predictor of mortality based on multivariate analysis (odds ratio ۵.۴۰, CI ۱.۱۹-۲۴.۵۴, P=۰.۰۲۹). Hypoalbuminemia was independently associated with a greater length of stay by ۲.۲ days after stage ۱ (P=۰.۰۰۲) and by ۱.۰ days after the second stage reimplantation (P=۰.۰۰۴).Conclusion: Preoperative hypoalbuminemia is a significant predictor of mortality and increased length of stay following two-stage revision but is not a predictor of failure of PJI treatment. Further study is required to understand if hypoalbuminemia is a modifiable risk factor or a marker for poor outcomes.Level of evidence: III

Albumin, Hypoalbuminemia, Periprosthetic joint infection, Two-stage