JOA - 2026-09-19 - Journal Article
Sobering Outcomes after Two-Stage Revision for Periprosthetic Joint Infection Among Patients Who Have Revision Total Knee Arthroplasty Components.
Ball JR, Palmer RC, Telang SS, Aron A, Bruce D, Jones-López EC, Longjohn DB, Oakes DA, Lieberman JR, Heckmann ND
Topics
Key Takeaway
Two-stage revision for PJI in revision TKA yields only 34.9% 10-year survivorship free from all-cause reoperation, with 8.1% requiring above-knee amputation.
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Summary
This study evaluated outcomes after complete explantation of infected revision TKA constructs (long stems, cones/sleeves, hinged, megaprosthetic components) at a single tertiary center. Of 62 knees, 24.2% required ICU admission post-explantation, 30.6% underwent unplanned reoperation, and 3.2% died within one year. Among the 77.4% who underwent reimplantation, 33.3% required subsequent reoperation with 56.2% of those for recurrent infection, yielding a 10-year reinfection-free survivorship of only 63.9%.
Key Limitation
Short and highly variable mean follow-up (3.4 ± 2.8 years) relative to the 10-year Kaplan-Meier projections produces wide confidence intervals that substantially limit the reliability of long-term survivorship estimates.
Original Abstract
INTRODUCTION
Periprosthetic joint infection (PJI) following revision total knee arthroplasty (TKA) is a major complication leading to substantial morbidity. Despite ongoing efforts, PJI remains the most common reason for failure following revision TKA. This study aimed to assess outcomes following the explantation of infected revision TKA components.
METHODS
A retrospective assessment was performed of patients treated with complete implant removal of a revision TKA construct for the diagnosis of PJI at a single tertiary academic center. Patient demographics, implants, intraoperative data, postoperative outcomes, and radiographic images were assessed. Revision components were defined as long stems, cones or sleeves, hinged components, or megaprosthetic components.
RESULTS
In total, 62 knees were evaluated with a mean follow-up of 3.4 ± 2.8 years. Construct features included long cemented stems in 44 (70.9%), hinged implants in 17 (27.4%), cones or sleeves in 15 (24.2%), and megaprosthetic components in 10 (16.1%). Mean operative time was 273.8 ± 91.5 minutes. Following explantation, 15 (24.2%) patients required intensive care unit admission, 16 (25.8%) required readmission within 90 days, 19 (30.6%) underwent unplanned reoperation, and 2 (3.2%) died within 1 year. Among the 48 (77.4%) replanted patients, 16 (33.3%) underwent subsequent reoperation, 9 (56.2%) for recurrent infection. At the last follow-up, 39 patients (62.9%) had re-revision implants in situ. There were seven patients (11.3%) who retained a static spacer, and 5 patients (8.1%) underwent above-knee amputation. Kaplan-Meier survivorship analysis demonstrated a 10-year survivorship estimate free from all-cause reoperation of 34.9% (95% Confidence Interval (CI): 17.2-71.0%) and survivorship free from reinfection of 63.9% (95% CI: 43.2-94.7%).
CONCLUSION
The management of PJI following revision TKA is a challenging surgical problem that is associated with significant patient morbidity when resection arthroplasty and spacer placement are performed. When considering explantation of revision TKA components, surgeons and patients should be aware of the substantial risk of postoperative complications.