Interim results show similar efficacy of one- and two-stage treatment for PJI
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Key takeaways:
- Patients had similar irrigation protocols, 6 weeks of IV antibiotics and 6 months of oral antibiotics after reimplantation.
- One-year success was defined as no reoperation for periprosthetic joint infection.
SAN FRANCISCO — The success rates of one-stage and two-stage treatment for periprosthetic joint infection may be similar, according to 1-year interim data presented at the American Academy of Orthopedic Surgeons Annual Meeting, here.
“We were surprised to find that in a contemporary American cohort with prospective data, one-stage and two-stage exchange at 1 year had similar results. Our bias from previous research in America was that two-stage [exchange] may have better outcomes,” Jesse E. Otero, MD, PhD, of OrthoCarolina Hip and Knee Center, told Healio.
In the prospective, randomized clinical trial, Otero and colleagues compared the results of one-stage and two-stage approaches for the treatment of PJI. Researchers randomized 321 patients with chronically infected primary hip arthroplasty or knee arthroplasty, as defined by MSIS criteria with a known organism. They used the tiered-outcome system for success, which was primarily defined as infection eradication. Researchers also wanted to determine the association of patient comorbidities, resistant organisms and draining sinuses.
Overall, 164 patients received a one-stage revision and 157 patients had two-stage revision. All patients had double surgical setup, similar irrigation protocols, 6 weeks of IV antibiotics initially and 6 months of oral antibiotics after reimplantation. Researchers excluded patients with revisions, fungal infections, immunosuppression or soft tissue involvement precluding wound closure. Researchers defined 1-year success as no reoperation for PJI.
In the 1-year interim analysis, researchers compared the success rates of 128 patients with a one-stage revision and 117 patients with two-stage revision. Otero said the 1-year success rate was 98% for one-stage revision and 92% for two-stage revision, and statistical analysis showed no difference.
“Our findings are exciting, but we have to wait for the final 2-year follow-up, which should be coming out next year. If the 1-year results hold true, it would mean less morbidity for patients and a smaller economic burden on the health care system in caring for PJI patients,” Otero told Healio. “It has been a massive team effort to carry out this study, and it would not be possible without the work of our collaborators, and our respective research teams who worked tirelessly to enroll patients, secure reliable follow-up and submit data.”
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Fehring TK, et al. Paper 85. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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