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

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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Acknowledgements

JvdK would like to thank Dr G.A.M. Govaert for her supervision of doctoral thesis and the Orthopaedic Bioengineering Laboratory of Massachusetts General Hospital, Foundation ‘De Drie Lichten’ in the Netherlands, and Stichting Prof. Michaël-van Vloten Fonds for the grant supporting a research fellowship.

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Authors and Affiliations

  1. Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Janna van den Kieboom, Venkatsaiakhil Tirumala, Liang Xiong, Christian Klemt & Young-Min Kwon

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  1. Janna van den Kieboom
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  2. Venkatsaiakhil Tirumala
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Correspondence to Young-Min Kwon.

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van den Kieboom, J., Tirumala, V., Xiong, L. et al. Periprosthetic joint infection is the main reason for failure in patients following periprosthetic fracture treated with revision arthroplasty. Arch Orthop Trauma Surg 142, 3565–3574 (2022). https://doi.org/10.1007/s00402-021-03948-3

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