Risk Factors for Failure and Reinfection Following One-Stage Revision Total Knee Arthroplasty: A Matched Case-Control Study.

BACKGROUND

Limited evidence exists on risk factors for failure after one-stage revision for periprosthetic joint infection (PJI). This study aimed to characterize patients who failed one-stage revision for chronic knee PJI under broad inclusion criteria and to identify associated risk factors.

METHODS

We identified 44 patients who experienced failure after one-stage revision for chronic knee PJI between June 18, 2004, and August 23, 2025. Failure was defined as the need for any subsequent surgeries. During the same period, a 1:2 matched control group comprising 88 patients who did not have failure was selected, matched by age (± five years), sex, and surgery year (± five years). Conditional logistic regression analyses were performed to identify factors associated with failure and reinfection.

RESULTS

In the failure group, 52.3% (23 of 44) had sinus tracts, and 84.1% (37) failed within two years after one-stage revision. Reinfection occurred in 31 patients (70.4%). A history of multiple failed surgeries was significantly associated with failure (odds ratio [OR], 13.27; 95% confidence interval [CI], 1.43 to 123.48; P = 0.023), with the wide CI suggesting considerable imprecision. Operative time greater than 150 minutes was also significantly associated with failure (OR, 5.11; 95% CI, 1.83 to 14.27; P = 0.002). For reinfection, the same two factors remained significant, and polymicrobial infection was additionally identified as a risk factor (OR, 3.16; 95% CI, 1.12 to 9.40; P = 0.029).

CONCLUSIONS

We reported that most failures after one-stage revision occur within two years postoperatively. A history of multiple failed surgeries and operative time greater than 150 minutes were independent risk factors for failure. These factors also remained significant for reinfection, with polymicrobial infection additionally identified as a risk factor. These findings highlight the importance of identifying and managing these risk factors in patients undergoing one-stage revision.