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. 2024 Dec;144(12):5111-5119.
doi: 10.1007/s00402-024-05249-x. Epub 2024 Mar 2.

Two-stage total joint replacement for hip or knee septic arthritis: post-traumatic etiology and difficult-to-treat infections predict poor outcomes

Antonio Russo  1 , Filippo Migliorini  2   3 , Fortunato Giustra  1   4 , Francesco Bosco  5   6 , Alessandro Massè  1 , Giorgio Burastero  7
Affiliations

Two-stage total joint replacement for hip or knee septic arthritis: post-traumatic etiology and difficult-to-treat infections predict poor outcomes

Antonio Russo et al. Arch Orthop Trauma Surg. 2024 Dec.

Abstract

Purpose: Septic arthritis (SA) is a rare but significant clinical challenge in orthopedics that can impact patients' quality of life. This study aims to examine the clinical outcomes of patients undergoing two-stage total joint replacement (TJR) in hip and knee SA and analyze potential predictors of treatment failure.

Methods: A retrospective analysis was conducted using data from a prospectively collected institutional arthroplasty registry from January 1st, 2012, to January 1st, 2019. Patients with hip or knee SA who underwent a two-stage TJR and had at least two years of follow-up were included. Demographic characteristics, surgical variables, and outcomes were collected and analyzed from clinical and surgical data. Statistical analysis was performed using IBM SPSS Statistics, with statistical significance at p < 0.05.

Results: One hundred and fourteen patients (61 with hip SA, 53 with knee SA) were included in the study. The mean follow-up was 72.8 months. Postoperatively, both clinical and functional outcomes significantly improved, as indicated by the Hip Society Score (HHS) and Knee Society Score (KSS). The overall success rate of the two-stage protocol was 89.5%. Complications that did not require revision occurred in 21% of cases. The most identified pathogen was methicillin-sensitive Staphylococcus aureus (MSSA). Difficult-to-treat (DTT) infections and post-traumatic etiology were identified as predictors of treatment failure in patients undergoing two-stage TJR for hip and knee SA.

Conclusions: Two-stage TJR in hip and knee SA demonstrated favorable clinical outcomes at mid-term follow-up. The procedure significantly improved functional scores and achieved a high success rate, while DTT infections and post-traumatic etiology were associated with a higher risk of treatment failure.

Keywords: Hip; Knee; Septic arthritis; Total joint replacement; Treatment; Two-stage.

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Conflict of interest statement

Declarations. Ethical approval: The author’s institution’s Institutional Review Board (IRB) defined this study as exempt from IRB approval (retrospective study of an established surgical procedure). It was conducted following the ethical standards of the Declaration of Helsinki (1964), and written informed consent was obtained from all participants included in the study. Informed consent: All patients were informed about the study and consented to participate. Conflict of interest: All authors have no conflicts of interest for this study to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patients’ inclusion process. TJR: total joint replacement; PJI: periprosthetic joint infection; SA: Septic arthritis
Fig. 2
Fig. 2
Kaplan-Meier curves investigating the success rate of the two-stage protocol for the treatment of septic arthritis
See this image and copyright information in PMC

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