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. 2022 Dec;142(12):3565-3574.
doi: 10.1007/s00402-021-03948-3. Epub 2021 May 15.

Periprosthetic joint infection is the main reason for failure in patients following periprosthetic fracture treated with revision arthroplasty

Janna van den Kieboom  1 , Venkatsaiakhil Tirumala  1 , Liang Xiong  1 , Christian Klemt  1 , Young-Min Kwon  2
Affiliations

Periprosthetic joint infection is the main reason for failure in patients following periprosthetic fracture treated with revision arthroplasty

Janna van den Kieboom et al. Arch Orthop Trauma Surg. 2022 Dec.

Abstract

Introduction: Periprosthetic fracture after primary total hip and knee arthroplasty (THA; TKA) can be challenging, requiring open reduction internal fixation (ORIF), revision, or both. The aim of this study was to evaluate the outcomes and risk factors associated with re-revision surgery following failed revision arthroplasty for periprosthetic fracture.

Methods: A total of 316 consecutive THA patients and 79 consecutive TKA patients underwent a revision for periprosthetic fracture, of which 68 THA patients (21.5%) and 15 TKA patients (18.9%) underwent re-revision surgery. The most common indication for hip and knee re-revision was periprosthetic joint infection (PJI) in 28 THA patients (46.6%) and 11 TKA patients (47.8%).

Results: The complication rates of THA and TKA revision were 24.3% and 25.3% respectively, and 35.0% and 39.1% respectively for re-revision surgery at an average follow-up of 4.5 years. Periprosthetic joint infection was the most common indication for THA and TKA re-revision (46.7%; 47.8%) and third revision surgery (15.0%; 13.0%). Factors significantly contributing to an increased risk of THA and TKA re-revision included revision with plate fixation and revision with combined ORIF.

Conclusion: The overall complication rate of THA and TKA re-revision surgery following failed revision surgery for periprosthetic fracture was higher than of revision surgery. The most common indication for re-revision and third revision was periprosthetic joint infection. These findings may assist surgeons in the management and preoperative counseling of patients undergoing THA and TKA revision surgery for a periprosthetic fracture to optimize the outcomes for these patients.

Level of evidence: Level III, case-control retrospective analysis.

Keywords: Periprosthetic fracture; Periprosthetic joint infection; Re-revision; Revision; Total joint arthroplasty.

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