Application of a new lavage-suction technique in managing chronic periprosthetic joint infection : Short running...

Chronic periprosthetic joint infection (PJI) remains one of the most complex and burdensome complications in orthopaedic surgery. Although two-stage revision arthroplasty is the standard of care, limitations such as persistent biofilm-related infection, prolonged systemic antibiotic use, and elevated reinfection risk remain unresolved. This study investigates the efficacy of a novel lavage-suction (LS) protocol designed to improve interim infection control following first-stage revision for chronic PJI.

In this single-centre retrospective cohort study conducted between October 2019 and September 2023, 71 patients with confirmed chronic PJI undergoing two-stage revision were included. Patients were assigned to either the LS group (n = 33) or the conventional management (CM) group (n = 38). The LS group received continuous intra-articular lavage beginning on postoperative day one, consisting of 3,000 mL of sterile normal saline mixed with 300 mL of 5% povidone-iodine, administered twice daily for 7 days via a dual inflow-outflow catheter system. This was followed by low-pressure suction drainage (60-80 mmHg) for an additional 7 days. The CM group received standard postoperative care without lavage or suction. Primary endpoints included symptom resolution time, duration of systemic antibiotic therapy, re-debridement rate, inflammatory marker trajectories (CRP, ESR, WBC), interval to reimplantation, and reinfection rates at two-year follow-up.

Compared with the CM group, LS-treated patients showed significantly faster resolution of local symptoms (5.94 ± 1.48 vs. 6.87 ± 1.47 days; p = 0.010), shorter antibiotic duration (44.39 ± 5.45 vs. 64.21 ± 19.57 days; p < 0.001), and a lower rate of re-debridement (9.1% vs. 31.6%; p = 0.043). Postoperative inflammatory markers declined more rapidly in the LS group, with significant differences observed from day 3 through week 12. The average interval to second-stage reimplantation was significantly shorter in the LS group (78 ± 19 vs. 110 ± 22 days; p < 0.001). At two years, no reinfections were observed in the LS group, whereas three cases occurred in the CM group (7.89%).

The implementation of a continuous LS protocol using high-volume antiseptic irrigation and low-pressure drainage significantly improves interim infection control following first-stage revision for chronic PJI. This approach reduces systemic antibiotic exposure, lowers surgical burden, accelerates inflammatory resolution, and may reduce the risk of reinfection. Prospective, multicenter trials are warranted to validate these findings and to optimize irrigation parameters and antiseptic protocols.