Xuyang Cao,1 Zizi Zhao,2 Cheng Zhang,3 Bo Gao,1 Ruifang Dong,2 Lijie Ma1 

1Trauma Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China; 2Department of Orthopedics, North China Medical and Health Group Xingtai General Hospital, Xingtai, Hebei, People’s Republic of China; 3Department of Orthopedics, The First Central Hospital of Baoding City, Baoding, Hebei, People’s Republic of China

Correspondence: Lijie Ma, Trauma Center, The Third Hospital of Hebei Medical University, No. 102 Youyi North Street, Qiaoxi District, Shijiazhuang, Hebei, 050000, People’s Republic of China, Tel +86-17733299114, Email malijie305x@hebmu.edu.cn

Objective: To identify factors influencing clinical outcomes of revision surgery for periprosthetic joint infection (PJI) after unicondylar knee arthroplasty (UKA).
Methods: This retrospective study included 40 patients who underwent UKA revision for PJI (May 2009–May 2023). Patients were divided into responders (n=27, favorable outcomes: no infection, KSS ≥ 80, HSS ≥ 85 at 6 months) and non-responders (n=13, suboptimal outcomes: persistent infection or KSS < 80/HSS < 85). Inflammatory markers (CRP, WBC), Knee Society Score (KSS), and Hospital for Special Surgery (HSS) score were assessed. Multivariate logistic regression identified predictors of success.
Results: Non-responders had higher rates of diabetes (46.2% vs 14.8%), smoking (30.8% vs 18.5%), alcohol use (23.1% vs 14.8%), Gram-positive infections (30.8% vs 11.1%), and deep infections (84.6% vs 22.2%, all P< 0.05). Key predictors of success included optimal antibiotic management (OR=1.33, 95% CI=1.02– 1.74), patient compliance (OR=1.44, 95% CI=1.08– 1.92), and absence of diabetes (OR=1.54, 95% CI=1.24– 1.98), smoking (OR=1.60, 95% CI=1.08– 2.37), or Gram-positive infections (OR=1.46, 95% CI=1.12– 1.90, all P< 0.05).
Conclusion: Diabetes, smoking, alcohol use, Gram-positive infections, deep infection, antibiotic management, and compliance significantly impact UKA revision outcomes. Smoking showed the strongest association (OR=1.60). Clinicians should prioritize preoperative optimization (glycemic control, smoking cessation) and protocol-driven antibiotic use. Findings are exploratory due to small sample size and require validation in larger cohorts.

Keywords: unicondylar knee arthroplasty, periprosthetic infection, revision surgery, clinical outcomes, influencing factors