JOA - 2026-04-08 - Journal Article
Risk Factors for Failure and Reinfection Following One-Stage Revision Total Knee Arthroplasty: A Matched Case-Control Study.
Yang C, Ji B, Li G, Zhang X, Wang Y, Cao L
Topics
Key Takeaway
Among 44 failure cases after one-stage revision TKA for chronic PJI, history of multiple prior failed surgeries (OR 13.27) and operative time >150 minutes (OR 5.11) were independent risk factors for both failure and reinfection, with 84.1% of failures occurring within two years.
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Summary
This matched case-control study identified risk factors for failure and reinfection after one-stage revision TKA for chronic PJI using broad inclusion criteria at a single institution from 2004–2025. Forty-four failure patients were matched 1:2 to 88 non-failure controls by age, sex, and revision year; conditional logistic regression identified multiple prior failed surgeries (OR 13.27), operative time >150 minutes (OR 5.11), and polymicrobial infection (OR 3.16, reinfection only) as independent risk factors. Reinfection accounted for 70.4% of failures, and 52.3% of failure patients had sinus tracts preoperatively.
Key Limitation
The small failure cohort (n=44) produces severely underpowered estimates with wide confidence intervals, making the OR for multiple failed surgeries (1.43–123.48) clinically uninterpretable for precise risk stratification.
Original Abstract
BACKGROUND
Existing evidence on risk factors for failure after one-stage revision of periprosthetic joint infection (PJI) is limited. This study aimed to characterize patients who failed one-stage revision for chronic knee PJI under broad inclusion criteria and to identify associated risk factors.
METHODS
There were 44 patients who experienced failure following one-stage revision for chronic knee PJI between June 18, 2004 and August 23, 2025 identified. Failure was defined as the need for any subsequent surgeries after one-stage revision. During the same period, a 1:2 matched control group comprising 88 patients who did not have failure was selected. Matching was based on age (± five years), sex, and year of one-stage revision (± five years). Conditional logistic regression analyses were performed to identify factors associated with failure and reinfection.
RESULTS
In the failure group, 52.3% (23 of 44) had sinus tracts, and 84.1% (37) experienced failure within two years after one-stage revision. Reinfection occurred in 31 patients (70.4%). A history of multiple failed surgeries was significantly associated with failure (odds ratio [OR], 13.27; 95% confidence interval [CI], 1.43 to 123.48; P = 0.023), with the wide CI suggesting considerable imprecision. Operative time greater than 150 minutes was also significantly associated with failure (OR, 5.11; 95% CI, 1.83 to 14.27; P = 0.002). For reinfection, risk factors included history of multiple failed surgeries (OR, 13.27; 95% CI, 1.43 to 123.48; P = 0.023), operative time greater than 150 minutes (OR, 5.11; 95% CI, 1.83 to 14.27; P = 0.002), and polymicrobial infection (OR, 3.16; 95% CI, 1.12 to 9.40; P = 0.029).
CONCLUSION
We reported that most failures after one-stage revision occur within two years postoperatively. A history of multiple failed surgeries and operative time greater than 150 minutes were independent risk factors for failure. These factors also remained significant for reinfection, with polymicrobial infection additionally identified as a risk factor. These findings highlight the importance of identifying and managing these risk factors in patients undergoing one-stage revision.