Outcome of Two-Stage Revision Total Hip and Knee Arthroplasty as a Salvage Procedure for Deep Infection of Peri-Articular Fracture Fixation: Propensity Score-Matched Study

Document Type : RESEARCH PAPER


Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA


Background: Failed open reduction internal fixation (ORIF) of peri-articular fractures due to deep infection is associated
with decreased functional outcomes and increased mortality rates. Two-stage revision total joint arthroplasty (TJA) is
often needed as a salvage procedure. The aim of this study was to evaluate the outcome of two-stage revision total
hip and knee arthroplasty as a salvage procedure for the treatment of deep infection of peri-articular fracture fixation.
Methods: Using propensity score-matching, a total of 120 patients was evaluated: 1) 40 consecutive patients were
treated with planned salvage two-stage revision for the treatment of deep peri-articular infection, and 2) a control
group of 80 patients who underwent two-stage revision for periprosthetic joint infection (PJI) after non-IF TJA. An
infection occurred after a fracture of the acetabulum (27.5%), femoral neck (22.5%), intertrochanteric femur (15.0%),
subtrochanteric femur (5.0%), femoral shaft (7.5%), distal femur (5.0%), and tibia (15.0%).
Results: At an average follow up of 4.5 years (range, 1.0-25.8), the overall failure rate was 42.5% for the IF group
compared to 21.3% for the non-ORIF group (P=0.03). There was a significantly higher reinfection rate for the IF group
compared to the non-IF group (35.0% vs. 11.3%, p=0.005). Tissue cultures for the IF patients demonstrated significantly
higher polymicrobial growth (30.0% vs. 11.3%, P=0.01) and methicillin-resistant Staphylococcus aureus (20.0% vs.
7.5%, P=0.04).
Conclusion: Salvage two-stage revision arthroplasty for infected IF of peri-articular fractures was associated with
poor outcome. The overall post-operative complications after salvage two-stage revision for infected IF of peri-articular
fractures was high with 35% reinfection rates associated with the presence of mixed and resistant pathogens.
Level of evidence: III


  • Receive Date: 25 August 2020
  • Revise Date: 10 October 2020
  • Accept Date: 02 January 2022
  • First Publish Date: 15 February 2022