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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
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Early Administration of Rifampicin Does Not Induce Increased Resistance in Septic Two-Stage Revision Knee and Hip

Leonard Grünwald1,2, Benedikt Paul Blersch1,2, Bernd Fink1,3

  • 1Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.

Antibiotics (Basel, Switzerland)
|June 25, 2025
PubMed

Insights

Starting rifampicin on the second postoperative day for periprosthetic joint infection (PJI) treatment showed low rates of rifampicin resistance (0.9%-1.4%). This timing is safe and effective for two-stage revision surgery in PJI patients.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Periprosthetic joint infection (PJI) is a serious complication following arthroplasty, affecting approximately 2% of patients.
  • Optimized antibiotic regimens are crucial for PJI management, with rifampicin often used in combination therapy.
  • The optimal timing for initiating rifampicin treatment to prevent resistance remains debated.

Purpose of the Study:

  • To evaluate the safety and efficacy of initiating rifampicin combination therapy on the second postoperative day in patients undergoing two-stage revision surgery for PJI.
  • To assess the incidence of rifampicin resistance development during and after treatment.

Main Methods:

  • Retrospective study of 212 patients with PJI undergoing two-stage revision surgery (THA and TKA).
  • Patients received individualized rifampicin combination therapy starting on the second postoperative day after debridement and foreign material removal.
  • Rifampicin resistance was monitored at spacer explantation and long-term follow-up.

Main Results:

  • A low incidence of rifampicin resistance was observed: 0.9% at spacer explantation and 1.4% at long-term follow-up.
  • The overall reinfection rate requiring further treatment was 11.8% in the study group.
  • No significant increase in resistance was noted between the first and second stages of surgery.

Conclusions:

  • Initiating rifampicin combination therapy on the second postoperative day is associated with a low risk of developing rifampicin resistance in PJI patients.
  • This therapeutic approach appears safe and effective for two-stage revision surgery, allowing sufficient concentrations of companion antibiotics.
  • Early administration of rifampicin on postoperative day two is a viable strategy in managing periprosthetic joint infections.
Keywords:
arthroplastyperiprosthetic joint infectionrifampicintwo-stage revision

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