outcome of two-stage revision total hip and knee arthroplasty as a salvage procedure for deep infection of peri-articular fracture fixation: propensity score-matched study

Background: failed open reduction internal fixation (orif) of peri-articular fractures due to deep infection is associated with decreased functional outcomes and increased mortality rates. two-stage revision total joint arthroplasty (tja) is often needed as a salvage procedure. the aim of this study was to evaluate the outcome of two-stage revision total hip and knee arthroplasty as a salvage procedure for the treatment of deep infection of peri-articular fracture fixation. methods: using propensity score-matching, a total of 120 patients was evaluated: 1) 40 consecutive patients were treated with planned salvage two-stage revision for the treatment of deep peri-articular infection, and 2) a control group of 80 patients who underwent two-stage revision for periprosthetic joint infection (pji) after non-if tja. an infection occurred after a fracture of the acetabulum (27.5%), femoral neck (22.5%), intertrochanteric femur (15.0%), subtrochanteric femur (5.0%), femoral shaft (7.5%), distal femur (5.0%), and tibia (15.0%). results: at an average follow up of 4.5 years (range, 1.0-25.8), the overall failure rate was 42.5% for the if group compared to 21.3% for the non-orif group (p=0.03). there was a significantly higher reinfection rate for the if group compared to the non-if group (35.0% vs. 11.3%, p=0.005). tissue cultures for the if patients demonstrated significantly higher polymicrobial growth (30.0% vs. 11.3%, p=0.01) and methicillin-resistant staphylococcus aureus (20.0% vs. 7.5%, p=0.04). conclusion: salvage two-stage revision arthroplasty for infected if of peri-articular fractures was associated with poor outcome. the overall post-operative complications after salvage two-stage revision for infected if of peri-articular fractures was high with 35% reinfection rates associated with the presence of mixed and resistant pathogens.