High Failure Rates of Concomitant Periprosthetic Joint Infection and Extensor Mechanism Disruption

Background: Patients presenting with both chronic periprosthetic joint infection (PJI) and extensor mechanism disruption (EMD) pose a significant challenge. As there is little in the literature regarding outcomes of patients with concomitant PJI and EMD, we performed a multicenter study to evaluate the outcomes.

Methods: Sixty patients with concomitant diagnoses of PJI and EMD were evaluated from 5 institutions. Patient demographics, presentation type, surgical management, and outcomes including recurrent infections, final surgery, and ambulatory status were documented.

Results: Fifty-three of 60 patients had an attempted extensor mechanism reconstruction/repair (EMR) of which 12 (23%) were successful, averaging 3.5 (range, 2-7) intervening surgeries. Forty-one patients (77%) were considered failures with recurrence of infection as most common failure (80%); 26 ended in fusion, 10 in above knee amputation, 3 with chronic resection arthroplasty, and 2 with chronic spacers/EMD. Seven patients had no attempt at EMR but proceeded directly to fusion (n = 6) or amputation (n = 1). There was no statistical difference between groups that had success or failure of EMR in age, American Society of Anesthesiologists Physical Status Classification System, or body mass index.

Conclusion: Our study demonstrates that concomitant EMD and PJI is a dreaded combination with poor outcomes regardless of treatment. Eradication of infection and reconstruction of the extensor mechanism often require numerous surgeries and despite great effort often end in failure. Consideration of early fusion or amputation may be preferable in some patients to avoid the morbidity and mortality of repeated surgeries.