The Role and Timing of Treatment Strategies During Two-Stage Revision for Periprosthetic Joint Infections.
Review
Overview
abstract
INTRODUCTION: Prosthetic joint infection continues to be a source of significant morbidity to patients and an economic burden to society as a whole. Two-stage revision is the current gold standard for treatment of periprosthetic joint infection in North America. Despite this, much discussion persists about treatment strategies surrounding the interim of the two-stage revision and treatment beyond reimplantation. The aim of this review is to answer some of these questions, specifically: are C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) helpful prior to reimplantation, is aspiration helpful, what is the role and timing for systemic antibiotics, and is there a role for oral suppression following second-stage reimplantation? METHODS: A literature review was completed in an attempt to address unanswered questions associated with two-stage reimplantation. Investigators' recommendations and current practices are described. RESULTS: ESR and CRP are less reliable in the interim of a two-stage revision than for diagnosis of infection in a primary total joint arthroplasty. There is inconclusive evidence regarding the utility of joint aspiration in two-stage revisions. Additionally, no evidence has been developed for length of IV antibiotic treatment after second-stage reimplantation, and in a few studies, oral antibiotic suppression has shown some benefit in reducing reinfection rates. CONCLUSION: The question of optimum treatment strategies has yet to be answered: attempts are underway to obtain suitable data with multi-center studies and large patient populations. Periprosthetic joint infection is a serious and life altering complication and with continued research we can further clarify treatment strategies.
