Eligibility for One-Stage Exchange Arthroplasty for Knee Periprosthetic Joint Infection Predicts Survivorship: A Retrospective Analysis of 509 Cases.
(2025) Journal of Arthroplasty — Vol. 40, n° 9S1, p. S507-S513 (2025)
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- BACKGROUND: Although two-stage exchange arthroplasty remains the gold standard for chronic total knee arthroplasty (TKA) periprosthetic joint infection (PJI), one-stage exchange arthroplasty is gaining popularity. The proportion of TKA PJIs eligible for one-stage exchange arthroplasty remains unknown. We aimed to determine how many patients who underwent two-stage exchange arthroplasty would have met eligibility criteria for one-stage exchange arthroplasty and the impact of eligibility on outcomes. METHODS: From 2000 to 2020, we identified 509 two-stage exchange arthroplasties for TKA PJI. The mean age was 66 years, the mean body mass index was 34, and 58% were men. Patients were considered eligible for one-stage exchange arthroplasty if they had unilateral PJI with susceptible bacteria identified preoperatively that was not fungal or multiresistant, were a McPherson A host, had no prior two-stage exchange arthroplasty, had an absence of severe bone or soft tissue loss, and were not septic. Cumulative incidences of reoperation for infection, re-revision for infection, any reoperation, and any re-revision were compared using a competing risk model. The mean follow-up was 5 years. RESULTS: Only 20% met eligibility criteria for one-stage exchange arthroplasty. The most common reasons for ineligibility were host grade (54%), and unknown organism (22%). The 2-year cumulative incidences of reoperation for infection and re-revision for infection for ineligible and eligible patients were 13 and 11% (P = 0.49), and nine and 6% (P = 0.3), respectively. The 2-year cumulative incidences of any reoperation and any re-revision for ineligible and eligible patients were 20 and 15% (P = 0.09) and 13 and 7% (hazard ratio = 2, P = 0.02), respectively. CONCLUSIONS: Only 20% of patients who underwent two-stage exchange arthroplasty met published eligibility criteria for one-stage exchange arthroplasty. The two-fold increased re-revision rate in patients ineligible for one-stage exchange arthroplasty should be considered when analyzing evolving data. LEVEL OF EVIDENCE: IV (retrospective).
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Elmenawi, K. A., Mallinger, B. D., Poilvache, H., Hannon, C. P., Abdel, M. P., & Bedard, N. A. (2025). Eligibility for One-Stage Exchange Arthroplasty for Knee Periprosthetic Joint Infection Predicts Survivorship: A Retrospective Analysis of 509 Cases. Journal of Arthroplasty, 40(9S1), S507-S513. https://doi.org/10.1016/j.arth.2025.04.017 (Original work published 2025)