JOA - 2026-04-13 - Journal Article
Revision Total Knee Arthroplasty for Aseptic Failure After Staged Exchange for Periprosthetic Joint Infection: High Rates of Reoperation and Reinfection.
Poilvache H, Ji B, Froerer DL, Hannon CP, Abdel MP, Bedard NA
Topics
Key Takeaway
Revision TKA for aseptic failure after two-stage exchange for PJI carries a 43% reoperation rate and 20% reinfection rate at 5 years, with 9% ultimately requiring amputation.
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Summary
This study evaluated 5-year survivorship of revision TKA performed for aseptic failure in patients with a prior history of successful two-stage exchange for PJI. Ninety-four aseptic revision TKAs (median 4 prior surgeries, BMI 35) were reviewed; indications included aseptic loosening (57%), instability (16%), and periprosthetic fracture (6%). Five-year survivorship free of any reoperation was 57%, free of revision was 66%, and free of PJI reoperation was 80%, with 8 patients (9%) ultimately requiring amputation.
Key Limitation
The absence of a matched control group of aseptic revision TKAs without prior PJI history prevents quantification of the incremental risk attributable to the prior infection versus the complexity of multiply-operated knees.
Original Abstract
BACKGROUND
Data are limited regarding the outcomes of revision total knee arthroplasty(TKA) for aseptic failure following the successful eradication of periprosthetic joint infection(PJI) with two-stage exchange. The purpose of this study was to evaluate 5-year survivorship of revision TKA for aseptic failure in patients who have a history of two-stage exchange for PJI.
METHODS
We retrospectively reviewed 94 aseptic revision TKAs performed between 2000 and 2020 at a single institution in patients who had previously completed two-stage exchange for PJI in the same knee. The mean age was 65 years, the mean body mass index(BMI) was 35, and 44% were women. The median number of surgeries before index aseptic revision TKA was four. There were no patients who met MSIS criteria for PJI or had positive cultures at the time of aseptic revision. The most common indications for aseptic TKA revision included aseptic loosening(57%), instability(16%), and periprosthetic fracture (6%). The mean follow-up was seven years.
RESULTS
The 5-year survivorships free of any reoperation and any revision were 57 and 66%, respectively. The 5-year survivorship free of reoperation for PJI was 80%. A total of 50 patients underwent reoperation, and nearly half of these were for PJI. The three most common indications for subsequent aseptic reoperation were extensor mechanism disruption, instability, and loosening. There were eight patients (9%) who ultimately required amputation for recurrent PJI.
CONCLUSION
Revision TKA for aseptic failure following two-stage exchange for PJI is associated with a high reoperation rate(43%) and high reinfection rate(20%) at five years. These data highlight the importance of robust fixation and knee balancing at the time of reimplantation to avoid subsequent surgeries that may lead to reinfection. While most of the index aseptic revision TKAs were for indisputable indications, these results suggest that surgeons should exercise caution when offering surgery for relative indications in this setting.