Two-stage Treatment for Hip and Knee Periprosthetic Infections

Two-stage exchange remains the standard of care for treatment of chronic periprosthetic infections in the United States. The strategy involves three steps; a resection arthroplasty with a thorough debridement and placement of a temporary spacer, an extended period of targeted antibiotics, and finally, a second definitive reconstruction procedure. The lengthy period of time between surgeries, where patients have diminished mobility, a long period of IV antibiotics and its considerable side effects, and the need for two large operations and hospitalizations places physiologic and emotional demands on patients and their families. A two-stage exchange has considerable morbidity and mortality, with significant attrition between stages. Nonetheless, it remains the gold standard for treatment of chronic periprosthetic infections, with good historic success rates. In this review, we outline its historical origins, surgical technique, outcomes and current research shaping two-stage exchanges. (Journal of Surgical Orthopaedic Advances 30(4):220-225, 2021).