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

Background: Failed open reduction internal fixation (ORIF) of peri-articular fractures due to deep infection is associatedwith decreased functional outcomes and increased mortality rates. Two-stage revision total joint arthroplasty (TJA) isoften needed as a salvage procedure. The aim of this study was to evaluate the outcome of two-stage revision totalhip 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 ۱۲۰ patients was evaluated: ۱) ۴۰ consecutive patients weretreated with planned salvage two-stage revision for the treatment of deep peri-articular infection, and ۲) a controlgroup of ۸۰ patients who underwent two-stage revision for periprosthetic joint infection (PJI) after non-IF TJA. Aninfection occurred after a fracture of the acetabulum (۲۷.۵%), femoral neck (۲۲.۵%), intertrochanteric femur (۱۵.۰%),subtrochanteric femur (۵.۰%), femoral shaft (۷.۵%), distal femur (۵.۰%), and tibia (۱۵.۰%).Results: At an average follow up of ۴.۵ years (range, ۱.۰-۲۵.۸), the overall failure rate was ۴۲.۵% for the IF groupcompared to ۲۱.۳% for the non-ORIF group (P=۰.۰۳). There was a significantly higher reinfection rate for the IF groupcompared to the non-IF group (۳۵.۰% vs. ۱۱.۳%, p=۰.۰۰۵). Tissue cultures for the IF patients demonstrated significantlyhigher polymicrobial growth (۳۰.۰% vs. ۱۱.۳%, P=۰.۰۱) and methicillin-resistant Staphylococcus aureus (۲۰.۰% vs.۷.۵%, P=۰.۰۴).Conclusion: Salvage two-stage revision arthroplasty for infected IF of peri-articular fractures was associated withpoor outcome. The overall post-operative complications after salvage two-stage revision for infected IF of peri-articularfractures was high with ۳۵% reinfection rates associated with the presence of mixed and resistant pathogens.Level of evidence: III

Keywords:

Deep infection , Open reduction internal fixation , Periprosthetic joint infection , Salvage procedure , Total joint arthroplasty