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Updated: Sep 1, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Repeat revision TKR for failed management of peri-prosthetic infection has long-term success but often require
Harshad Rajgor1, Huan Dong1, Raj Nandra1
1Trauma and Orthopaedic Registrar, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
Background:
Prosthetic joint infection (PJI) is associated with poor outcomes and catastrophic complications. The aim of this study was to present the outcomes of re-revision surgery for PJI of the knee following previous failed two-stage exchange arthroplasty.
Materials And Methods:
A retrospective analysis was performed of 32 patients who underwent re-revision knee arthroplasty, having already undergone at least one previous two-stage exchange for PJI with a minimum follow-up of two-years for alive patients. Outcomes were compared to a matched control of two-stage revisions for PJI of a primary knee replacement also containing 32 patients. Outcomes investigated were eradication of infection, re-operation, mortality and limb-salvage rate.
Results:
Successful eradication of infection was achieved in 50% of patients following re-revision surgery, compared with 91% following two-stage exchange of primary knee replacement for PJI (p < 0.001). Fourteen (44%) patients required further re-operation compared with three (9%) patients in the primary group (p = 0.006). Amputation was performed in one case (3%) with thirteen patients (92%) who had infection controlled by debridement, antibiotics and implant retention (DAIR), further revision surgery or arthrodesis. Two patients died with infection (6%) and the long-term rate for infection control was 91%. The mean number of procedures following surgery for the re-revision group was 2.8 (0-9) compared with 0.13 (0-1) for the primary two-stage group (p < 0.001). Five-year patient survival was 90.6% (95% CI 77.1-100). The limb-salvage rate for the re-revision cohort was 97%.
Conclusion:
Outcomes for re-revision knee arthroplasty for PJI have higher re-operation and failure rates, but no worse mortality than in revisions of primary knee replacements. Failures can successfully be managed by further operation.
Insights
Re-revision knee surgery for prosthetic joint infection (PJI) shows lower infection eradication rates and higher re-operation needs. However, mortality is similar to primary revisions, and failures can be managed with further intervention.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biomaterials Science
Background:
- Prosthetic joint infection (PJI) leads to severe complications and poor patient outcomes.
- Two-stage exchange arthroplasty is a common treatment for PJI.
- Re-revision surgery for persistent PJI after a two-stage exchange presents unique challenges.
Purpose of the Study:
- To evaluate the outcomes of re-revision knee arthroplasty following a prior failed two-stage exchange for PJI.
- To compare re-revision outcomes with those of primary two-stage exchange arthroplasty for PJI.
Main Methods:
- Retrospective analysis of 32 patients undergoing re-revision knee arthroplasty for PJI.
- Minimum two-year follow-up for surviving patients.
- Comparison with a matched control group of 32 patients undergoing primary two-stage exchange for PJI.
- Outcomes assessed included infection eradication, re-operation rates, mortality, and limb-salvage.
Main Results:
- Successful infection eradication was 50% in re-revision versus 91% in primary two-stage exchange (p < 0.001).
- Re-operation was required in 44% of re-revision patients compared to 9% in the primary group (p = 0.006).
- Mortality was 6% in the re-revision group, with a 97% limb-salvage rate.
Conclusions:
- Re-revision knee arthroplasty for PJI has higher failure and re-operation rates than primary two-stage exchange.
- Mortality rates are comparable between re-revision and primary two-stage exchange procedures.
- Further surgical intervention can effectively manage failures in re-revision cases.
