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.
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.
Entities:
Keywords:
Deep infection; Open reduction internal fixation; Periprosthetic joint infection; Salvage procedure; Total joint arthroplasty
Authors: Andrew D Duckworth; Sally-Anne Phillips; Oliver Stone; Matthew Moran; Steffen J Breusch; Leela C Biant Journal: Injury Date: 2012-04-27 Impact factor: 2.586
Authors: David Wasserstein; Patrick Henry; J Michael Paterson; Hans J Kreder; Richard Jenkinson Journal: J Bone Joint Surg Am Date: 2014-01-15 Impact factor: 5.284
Authors: David J Stockton; Lyndsay M O'Hara; Nathan N O'Hara; Kelly A Lefaivre; Peter J O'Brien; Gerard P Slobogean Journal: Acta Orthop Date: 2019-02 Impact factor: 3.717