Timing of Failure of Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection of the Hip and Knee.

Abstract

While numerous risk factors have been associated with failure following a two-stage exchange for periprosthetic joint infection (PJI), little prior research has evaluated specifically when failure occurs postoperatively. The purpose of this study was to investigate the timing of failure following a two-stage exchange for chronic PJI and to determine whether any patient- or organism-specific risk factors are associated with early failure. From our institutional registry, we identified 589 two-stage exchanges performed for PJI of the hip or knee from 2010 to 2021. After excluding patients for lack of failure (n = 357) and inadequate chart information (n = 142), we were left with 90 (15% of 589) total joint arthroplasties (56 knees and 34 hips) in 90 patients that failed following a two-stage exchange. These patients were divided into two groups by the timing of failure: early (within 5 years postoperatively) and late (> 5 years postoperatively). Potential patient- and organism-specific risk factors for failure were compared between groups. The median time to failure was 579 days (interquartile range, 204 to 1,246). The cumulative percentage of patients who failed within 1, 5, and 10 years following reimplantation was 40, 84, and 98%, respectively. Systemic inflammatory disease was associated with early failure (n = 21 early failures versus n = 0 late failures; P = 0.03), with 100% of patients who had systemic inflammatory disease failing early. A resistant organism identified intraoperatively trended toward being significantly associated with early failure (n = 16 early failures versus n = 0 late failures; P = 0.10). Most failures following a two-stage exchange (84%) occurred early, within 5 years following reimplantation. Patients with systemic inflammatory disease and/or a resistant organism identified intraoperatively were most at risk for early failure. These data may guide surgeons regarding follow-up monitoring and the duration of suppressive antibiotics. Level IV, retrospective review.