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Predictors of failure of two-stage revision in periprosthetic knee infection: a retrospective cohort study with a minimum two-year follow-up

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

Abstract

Purpose

Despite the standardization of two-stage knee revision protocols, a high percentage of failures still occurs. Identifying the predictors of failure is necessary to determine appropriate management and counsel for patients with a periprosthetic knee infection. This study aimed to identify risk factors predicting the failure, to describe implant survival, and to report the mid-term clinical outcomes of patients undergoing two-stage revision for periprosthetic knee infection.

Methods

Data of patients who underwent two-stage knee revision from 2012 to 2016 were analyzed, and 108 patients were included. The mean age was 66.6 ± 9.2 years. The mean follow-up was 52.9 ± 15.6 months. Logistic regression was conducted to identify predictors of treatment failure. Kaplan–Meier curves were generated to assess implant survival. Preoperative functional outcomes were compared to those registered at the final follow-up.

Results

Difficult-to-treat infections (OR = 4.2, 95% CI 1.2–14.5, p = 0.025), the number of previous surgeries (OR = 1.8, 95% CI 1.2–2.6, p = 0.005), and the level of tibial bone defect (OR = 2.3, 95% CI 1.1–4.7, p = 0.027) significantly predicted the failure of two-stage knee revision. Survivorship of implants was significantly lower for patients presenting these risk factors (p < 0.05). Mean Knee Society Score improved from 49.0 ± 12.0 to 80.2 ± 13.6 (p < 0.001). Mean Oxford Knee Score improved from 22.2 ± 4.9 to 36.1 ± 6.0 points (p < 0.001).

Conclusion

Difficult-to-treat pathogens, the number of previous surgeries, and the level of tibial bone defect were independent risk factors of two-stage knee revision failure. Overall, the two-stage protocol provided a good survival rate and functional outcome.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy

    Antonio Russo, Mattia Alessio-Mazzola & Lamberto Felli

  2. Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy

    Antonio Russo, Mattia Alessio-Mazzola & Lamberto Felli

  3. Joint Arthroplasty Unit, Orthopaedic and Traumatology 2, Santa Corona Hospital, Viale 25 Aprile 38, 17027, Pietra Ligure, Italy

    Luca Cavagnaro & Francesco Chiarlone

  4. Prosthetic Surgery Centre, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy

    Giorgio Burastero

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  1. Antonio Russo
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Contributions

AR: data analysis, methodology, original draft writing. LC: conceptualization, original draft writing. FC: conceptualization, data collection and material organization. MA-M: review and editing of the original draft. LF and GB: supervision, project administration, review and editing of the original draft.

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Correspondence to Giorgio Burastero.

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Russo, A., Cavagnaro, L., Chiarlone, F. et al. Predictors of failure of two-stage revision in periprosthetic knee infection: a retrospective cohort study with a minimum two-year follow-up. Arch Orthop Trauma Surg 142, 481–490 (2022). https://doi.org/10.1007/s00402-021-04265-5

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