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

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. Using propensity score-matching, a total of 120 patients was evaluated: 1) 40 consecutive patients weretreated with planned salvage two-stage revision for the treatment of deep peri-articular infection, and 2) a controlgroup of 80 patients who underwent two-stage revision for periprosthetic joint infection (PJI) after non-IF TJA. Aninfection 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%). At an average follow up of 4.5 years (range, 1.0-25.8), the overall failure rate was 42.5% for the IF groupcompared to 21.3% for the non-ORIF group (P=0.03). There was a significantly higher reinfection rate for the IF groupcompared to the non-IF group (35.0% vs. 11.3%, p=0.005). Tissue cultures for the IF patients demonstrated significantlyhigher polymicrobial growth (30.0% vs. 11.3%, P=0.01) and methicillin-resistant Staphylococcus aureus (20.0% vs.7.5%, P=0.04). 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 35% reinfection rates associated with the presence of mixed and resistant pathogens.Level of evidence: III