One-Stage Versus Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: A Prospective Randomized Trial.

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Clinical Trials

Background:

• Periprosthetic joint infection (PJI) is commonly treated with a two-stage surgical approach.
• Previous one-stage PJI treatment studies were limited by small sample sizes and exclusion of complex cases.
• The high morbidity and cost of two-stage PJI treatment necessitate investigation into alternative methods.

Purpose of the Study:

• To prospectively compare the efficacy of one-stage versus two-stage treatment for chronic periprosthetic joint infection (PJI).
• To include patients with challenging conditions such as draining sinuses, comorbidities, and antibiotic-resistant organisms in the comparison.
• To evaluate clinical success rates at two-year follow-up for both treatment modalities.

Main Methods:

• A prospective, multicenter, randomized trial involving 323 patients with chronic PJI following primary total hip or knee arthroplasty.
• Patients were randomized into either one-stage or two-stage treatment groups, with strict inclusion/exclusion criteria.
• Clinical success was defined as absence of failure, reinfection, reoperation for PJI, or PJI-related death, assessed at two-year follow-up.

Main Results:

• The two-year success rate for the one-stage treatment group was 97% (131/135), compared to 91% (112/123) for the two-stage group (p = 0.04).
• Regression analysis indicated that one-stage treatment had three times the odds of overall success compared to two-stage treatment, even after adjusting for host factors and organism resistance.
• Sixteen patients in the one-stage group and 9 in the two-stage group died before the two-year follow-up.

Conclusions:

• One-stage treatment is statistically non-inferior to two-stage treatment for chronic PJI in primary total hip or knee arthroplasty when specific protocols are followed.
• The findings support the one-stage approach as an effective alternative, particularly in complex patient populations.
• Results should be applied cautiously and not extrapolated to different patient cohorts or clinical scenarios.