Failed Two-Stage Exchange: Factors Leading to Unachievable Endoprosthetic Reconstruction After Multiple Revision Surgeries.

BACKGROUND: Information about the outcome after failed 2-stage exchange is scarce. The aim of this study is to determine possible influencing factors leading to multiple revisions, resulting in a failed endoprosthetic joint reconstruction.
METHODS: Medical records of patients (15 hip and 29 knee joints) who had undergone additional revision surgeries due to a failed 2-stage exchange were reviewed concerning infection parameters, number and type of procedure(s), current state of the revised joint, and whether failure of endoprosthetic reconstruction had occurred.
RESULTS: Endoprosthetic reconstruction was achieved in 52.3% (n = 23) of the patients. About 36.4% (n = 16) of patients successfully reached the second stage of the initial 2-stage exchange. Half of the patients (n = 22) had to undergo spacer exchange in the initial interstage period. Five or more revision surgeries significantly increased the odds of failure of endoprosthetic reconstruction compared to patients with <5 revision surgeries (odds ratio 4.98, 95% confidence interval 1.34-18.4, P = .016). Patients with initial culture-negative revision surgery showed no significant differences in the odds of failure of endoprosthetic reconstruction (odds ratio 0.69, 95% confidence interval 0.20-2.43, P = .567).
CONCLUSION: Patients undergoing re-revision surgery due to a failed 2-stage exchange are very likely to ultimately experience a failed endoprosthetic reconstruction. The identification of the underlying pathogen does not influence the likelihood of a better outcome in terms of a successful endoprosthetic reconstruction.