Endoprosthetics of joints after osteosynthesis for traumatic bone damage

Abstract

Background. Patients who have undergone osteosynthesis for fractures of bones and joints often subsequently require arthroplasty. A history of infection at the metal implant site may significantly influence the outcomes of joint replacement. The aim of this study was to compare the outcomes of primary arthroplasty following osteosynthesis in patients with and without fracture‑associated infection (FAI). Materials and Methods. A retrospective analysis was performed on 695 cases of primary arthroplasty of the hip, knee, shoulder, and elbow joints in patients with a history of osteosynthesis between 2016 and 2025. Patients were divided into two groups: Group 1 (with FAI, n=46) and Group 2 (without infection, n=649). Demographic data, laboratory markers (ESR, CRP, synovial fluid leukocyte count), microbial profile, surgical strategy, and arthroplasty outcomes (mechanical and infectious complications) were assessed. Results. The FAI group had a significantly higher proportion of male patients (71.7%, p=0.0334) and patients were younger (median age 52 vs 58 years). The hip joint was the most common anatomical site of injury in both groups (approximately 80%). Coagulase‑negative staphylococci predominated in the microbial profile (52.2%), with methicillin‑resistant strains accounting for 87.5%. Two‑stage arthroplasty was performed in 87% of cases in the FAI group, whereas 100% of patients in the infection‑free group underwent single‑stage procedures. Compared to the infection‑free group, patients with FAI had significantly higher odds of developing any postoperative complications (OR=8.70), including infectious (OR=8.73) and mechanical (OR=7.33); all differences were statistically significant (p0.01). The follow‑up duration in the FAI group was 4.1 years (95% CI: 3.4–4.9) versus 4.8 years (95% CI: 4.5–5.0) in the infection‑free group (p=0.4371). Conclusion. A history of FAI significantly increases the risk of infectious and mechanical complications after arthroplasty. Despite the preference for two‑stage treatment of FAI, the risk of infection remains high, underscoring the need for thorough preoperative diagnostic workup and personalized surgical management in these patients.