How many exchange arthroplasties are reasonable before a salvage operation (such as amputation or arthrodesis) should be considered?

Authors: Timothy L. Tan, Javad Mortazavi

RECOMMENDATION: Patients with a failed two-stage exchange arthroplasty that undergo a repeat two-stage exchange arthroplasty demonstrate poor outcomes. Failure of the repeat two-stage exchange arthroplasty appears to be dependent on the host grade and status of the extremity. Surgeons thus should consider the patient’s comorbidities and expectations when deciding whether to subject the patient to repeat two-stage exchange arthroplasties. The outcomes of a third or fourth two-stage exchange arthroplasty are dismal.

LEVEL OF EVIDENCE: Limited

DELEGATE VOTE: Agree: 88%, Disagree: 10%, Abstain: 2% (Super Majority, Strong Consensus)