Two-stage Exchange Arthroplasty for Infected Total Knee Arthroplasty: Predictors of Failure

  • S. M. Javad Mortazavi
  • David Vegari
  • Anthony Ho
  • Benjamin Zmistowski
  • Javad Parvizi
Symposium: Papers Presented at the 2010 Meeting of the Musculoskeletal Infection Society



In North America, a two-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint infection (PJI). Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage exchange or the appropriate conditions in which to reimplant.


To identify (1) the rate of recurrent PJI after two-stage exchange and (2) the role of 15 presurgical and 11 operative factors in influencing the outcome of two-stage revision.

Patients and Methods

From a prospective database we identified 117 patients who had undergone two-stage exchange arthroplasty for PJI of the knee from 1997 to 2007. Failure of two-stage revision was defined as any treated knee requiring further treatment for PJI. We identified 15 presurgical and 11 surgical factors that might be related to failure. Minimum followup was 2 years (average, 3.4 years; range, 2–9.4 years).


Thirty-three of 117 reimplantations (28%) required reoperation for infection. Age, gender, body mass index, and comorbidity indices were similar in both groups. Multivariate analysis provided culture-negative (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3–15.7), methicillin-resistant organisms (OR, 2.8; 95% CI, 0.8–10.3), and increased reimplantation operative time (OR, 1.01; 95% CI, 1.0–1.03) as predictors of failure. ESR and CRP values at the time of reimplantation and time from resection to reimplantation were not predictors.


Our observations suggest the failure rate after two-stage reimplantation for infected TKA is relatively high. Culture-negative or methicillin-resistant PJI increases the risk of failure over four- and twofold, respectively. We identified no variables that would guide the surgeon in identifying acceptable circumstances in which to perform the second stage.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.


Periprosthetic Joint Infection Recursive Partitioning Analysis Infected Total Knee Arthroplasty Prosthesis Retention Periprosthetic Knee Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Mitchell Maltenfort, PhD, for his assistance with statistical analysis on this project.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • S. M. Javad Mortazavi
    • 1
  • David Vegari
    • 1
  • Anthony Ho
    • 1
  • Benjamin Zmistowski
    • 1
  • Javad Parvizi
    • 1
  1. 1.The Rothman Institute of Orthopaedics at Thomas Jefferson University HospitalPhiladelphiaUSA

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