Two-stage exchange arthroplasty involves resection and reimplantation of new implants at a later stage. An antibiotic-free period is often advocated by surgeons before reimplantation. However, there is no conclusive evidence supporting the utility or duration of this practice. This study evaluated the utility and optimal duration of the antibiotic-free period before reimplantation.
Electronic infection databases of 2 institutions were retrospectively reviewed from 2000 to 2014 to identify 785 patients who underwent 2-stage exchange arthroplasty, of which 409 were reimplanted without any surgeries between the first and second stage. Total joint arthroplasties that met the Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) and had a minimum of 1-year follow-up were included. The antibiotic holiday period was defined as the time period off antibiotics before reimplantation. Treatment success was defined according to the Delphi consensus criteria. A multivariate analysis and Fisher exact test were performed.
The duration of the antibiotic-free period was not significantly associated with reinfection following reimplantation after controlling for potential confounders, including joint involvement, gender, institution, and comorbidities. However, the duration of spacer implantation was significantly associated with reinfection. Of the patients who failed treatment, 41.5% failed on antibiotics while 58.5% failed during the antibiotic-free period at a mean of 26.1 days.
The duration of an antibiotic-free period does not appear to significantly affect PJI rate after reimplantation. However, many patients fail during the antibiotic-free period. Further prospective studies are needed to determine the optimal timing of reimplantation for 2-stage exchange arthroplasty for PJI treatment.