Six-Week Protocol for Two-Stage Exchange Arthroplasty in a High-Risk Population

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Arthroplasty

Background:

• Periprosthetic joint infection (PJI) is a severe complication after total joint arthroplasty.
• The 2-stage exchange is the standard for PJI treatment, but optimal protocols are debated.
• This study evaluates a 6-week 2-stage exchange protocol for PJI in a high-risk cohort.

Purpose of the Study:

• To assess the efficacy of a standardized 6-week 2-stage exchange protocol for PJI.
• To evaluate infection eradication rates in hip and knee arthroplasties.
• To analyze outcomes in a high-risk population, including those with mega-prostheses.

Main Methods:

• Retrospective review of PJI patients treated between January 2018 and December 2022.
• Inclusion criteria: Musculoskeletal Infection Society (2018) PJI criteria and 6-week 2-stage exchange protocol.
• Primary outcome: infection eradication (no reoperation); secondary outcomes: pathogens, culture rates, mega-prosthesis outcomes.

Main Results:

• 88% infection eradication rate at minimum 1-year follow-up.
• Common pathogens included Staphylococcus aureus and coagulase-negative Staphylococcus.
• 40% of patients received suppressive antibiotic therapy for 1 year, predominantly those with mega-prostheses.

Conclusions:

• A 6-week 2-stage exchange protocol is effective for managing PJI in high-risk patients.
• The protocol demonstrated high eradication rates, comparable to or better than traditional methods.
• This shortened protocol may reduce costs and patient burden while maintaining efficacy.