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Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

A two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6–8 week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the influence of a short (< 4 weeks) and long (≥ 4 weeks) interval on reinfection rate and functional outcome of hip and knee PJI.

Methods

In this prospective cohort, patients undergoing two-stage revision for PJI were assigned to prosthesis reimplantation after a short (< 4 weeks) or long (≥ 4 weeks) interval. All patients received standardized antimicrobial therapy, which consisted of antibiogram-adapted, non-biofilm-active antibiotics during the interval and an antimicrobial combination therapy with biofilm-active antibiotics after reimplantation. Follow-up was performed for infection, joint function, pain, need for care and quality of life.

Results

Thirty-eight patients undergoing two-stage revision for PJI (18 hips and 20 knees) were included. Short interval was used in 19 patients having a mean interval of 17.9 days (range 7–27 days), long interval in 19 patients having a mean interval of 63.0 days (range 28–204 days). At a mean follow-up of 39.5 months (range 32–48 months), 37 of 38 patients (97.4%) were infection-free. One failure occurred among patients with long interval and none among patients with short interval. Functional results (ROM, HHS, KSS, VAS) and quality of life (SF-36) were similar in both groups. Patients treated with long interval required cumulatively additional 204 inpatient days for nursing care compared to patients with short interval.

Conclusions

This study suggests that two-stage exchange with short interval has a similar outcome than with long interval, when highly active antibiotic therapy is used. Patient inconvenience and care costs due to immobilization were lower when strategies with a short interval were used.

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Acknowledgements

We thank Anne Zergiebel for her excellent coordination work. We thank the interdisciplinary team of our ward for periprosthetic infections for their continuous effort to support an optimal treatment for our patients. The study was funded by a grant from Charité – Universitaetsmedizin Berlin.

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Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany

    Tobias Winkler, Malte G. W. Stuhlert, Elke Lieb, Michael Müller, Philipp von Roth, Bernd Preininger, Andrej Trampuz & Carsten F. Perka

  2. Julius Wolff Institute, Berlin, Germany

    Tobias Winkler

  3. Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany

    Tobias Winkler & Andrej Trampuz

  4. Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany

    Tobias Winkler, Malte G. W. Stuhlert, Elke Lieb, Michael Müller, Philipp von Roth, Bernd Preininger, Andrej Trampuz & Carsten F. Perka

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  1. Tobias Winkler
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  2. Malte G. W. Stuhlert
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  3. Elke Lieb
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Correspondence to Tobias Winkler.

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Winkler, T., Stuhlert, M.G.W., Lieb, E. et al. Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study. Arch Orthop Trauma Surg 139, 295–303 (2019). https://doi.org/10.1007/s00402-018-3052-4

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  • DOI: https://doi.org/10.1007/s00402-018-3052-4

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