One-Stage Versus Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: A Prospective Randomized Trial - PubMed
10 hours ago
- #Randomized Controlled Trial
- #Orthopedic Surgery
- #Periprosthetic Joint Infection
- The study is a prospective randomized trial comparing one-stage vs. two-stage exchange arthroplasty for treating chronic periprosthetic joint infection (PJI) following primary total hip or knee arthroplasty.
- Inclusion criteria involved chronic PJI with a known organism using MSIS criteria, while excluding prior revisions, culture-negative or fungal infections, immunosuppressed patients, or soft-tissue issues preventing wound closure.
- A total of 323 patients were randomized (166 one-stage, 157 two-stage), with 258 patients completing 2-year follow-up (135 one-stage, 123 two-stage).
- Clinical success was defined as no reinfection, no reoperation for PJI, and no PJI-related death.
- At 2 years, the success rate was 97% for one-stage treatment (131/135) and 91% for two-stage treatment (112/123), showing statistical noninferiority with a p-value of 0.04.
- One-stage treatment had three times the odds of success compared to two-stage, even after adjusting for variables like host grade, resistant organisms, and draining sinuses.
- The study included patients with draining sinuses, comorbidities, and antibiotic-resistant organisms, addressing previous limitations in research.
- Protocols included a double-instrument setup, similar irrigation, and antibiotic protocols across both groups.
- Deaths before follow-up were 16 in the one-stage group and 9 in the two-stage group, with similar loss to follow-up rates between groups.
- Conclusions indicate one-stage treatment is noninferior to two-stage when following specific protocols, cautioning against extrapolation to other patient cohorts.