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Optimal Duration of Antibiotic Holiday Before Reimplantation in Two-Stage Exchange Arthroplasty for Periprosthetic
Elizabeth K Carlino1, Kyle H Cichos, Craishun Hart
1From the Hughston Clinic, Columbus, GA (Carlino, Cichos, and Hart); the Rothman Orthopaedic Institute, Philadelphia, PA (Hohmann and Fillingham); the Department of Orthopaedic Surgery, University of Missouri, Columbia, MO (Leary and Ghanem); the Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL (Higuera); the Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (Pupaibool); the Department of Orthopaedic Surgery, Baylor Scott and White All Saints Medical Center, Fort Worth, TX (Nana).
Introduction:
Two-stage exchange arthroplasty is commonly used for the management of chronic periprosthetic joint infection (PJI). Along with many other aspects of this technique, the optimal duration of antibiotic holiday during the interstage period remains contentious. We aimed to answer this question through a systematic review and meta-analysis by synthesizing evidence from the current literature.
Methods:
Systematic review was conducted for studies reporting on two-stage exchange arthroplasty for the management PJI in total hip or total knee arthroplasty (TKA) published between January 1, 2013 and May 1, 2024. The meta-analysis included 14 studies reporting outcomes of two-stage exchange arthroplasty with antibiotic holidays for the treatment of chronic PJI following primary total hip arthroplasty or TKA, and the proportion of failed cases were analyzed using prediction models.
Results:
The pooled proportion of failed cases across studies of any length for antibiotic holiday was 18% (95% confidence interval [CI], 0.16 to 0.20). The proportion of failed cases in studies using an extended duration antibiotic holiday was 18% (95% CI, 0.16 to 0.20) versus 18% (95% CI, 0.15 to 0.23) for studies using a short duration.
Conclusion:
With the number available, the findings identified no notable difference in treatment failure rates with short (<2 weeks) or extended (≥2 weeks) antibiotic holiday duration between the two stages. However, the evidence is limited by substantial heterogeneity among studies, and further studies are necessary to appropriately address this topic.
Insights
The optimal duration of antibiotic holiday in two-stage exchange arthroplasty for periprosthetic joint infection (PJI) is unclear. This study found no significant difference in treatment failure rates between short and extended antibiotic holidays.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biostatistics
Background:
- Chronic periprosthetic joint infection (PJI) management often involves two-stage exchange arthroplasty.
- The ideal length of the antibiotic holiday between surgical stages is a subject of debate.
Conclusions:
- Current evidence suggests that both short (<2 weeks) and extended (≥2 weeks) antibiotic holiday durations are associated with similar treatment failure rates in two-stage exchange arthroplasty for PJI.
- Substantial heterogeneity exists among the reviewed studies, highlighting the need for further research to definitively address this clinical question.
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