The co-occurrence of peri-prosthetic fracture and infection: a scoping review on current diagnostic principles, treatment and outcome

Background : The co-occurrence of periprosthetic fractures and infection, referred to as infected periprosthetic fracture (iPPF), represents a highly burdensome complication in orthopedic surgery. Management is challenging since not rarely treatment principles of prosthetic joint infections and fracture-related infections have to be combined. The aim of this scoping review was to map the current literature on management and outcome of iPPFs. Methods : A scoping review was conducted in accordance with PRISMA-ScR guidelines. Five major databases were systematically searched. Studies reporting on diagnostic principles and/or treatment strategies for iPPF around the hip and knee were included. Data were mapped regarding study design, diagnostic approaches, surgical strategies, and outcome. Results : A total of 32 studies comprising 273 patients with iPPFs were included; 8 addressed diagnostic strategies, and 24 reported on treatment and outcome. Diagnostic studies demonstrated limited reliability of serum inflammatory markers, and although synovial fluid analysis appeared most informative, optimal thresholds remain uncertain. Most treatment studies were small and heterogeneous. A staged surgical approach, predominantly two-stage revision, was reported in 83 % of the included studies. Across nine studies reporting outcomes, mean infection eradication and recurrence rates were 76.1 % and 22.3 %, respectively. The majority of the studies (58.3 %) described that additional surgeries were needed to cure infection. Fracture healing outcomes were inconsistently reported (bone healing in 4 out of 9 studies with 53/58 fractures, mean 91.4 %). Conclusion : This scoping review demonstrates that management of iPPFs remains highly challenging, with high rates of recurrent infection and unplanned revision surgery. However, the reported quantitative outcome data represent descriptive summaries derived from heterogeneous, predominantly small observational studies and case series and should not be interpreted as definitive benchmarks for clinical outcomes. The current evidence base remains limited, highlighting the need for standardized diagnostic criteria, uniform outcome reporting, and well-designed prospective multicenter studies.