Rapid exchange arthroplasty may have higher treatment success rate vs. two-stage exchange
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Key takeaways:
- The experimental group had a higher success rate at 6 months compared with the control group.
- Stage-two reimplantation was completed by 100% of patients in the experimental group vs. 75% in the control group.
Results showed rapid exchange arthroplasty with intra-articular antibiotic irrigation for treatment of periprosthetic joint infection may have a higher rate of treatment success at 6 months compared with two-stage exchange arthroplasty.
Nicolas S. Piuzzi, MD, director of Cleveland Clinic Adult Reconstruction Research and co-director of the Musculoskeletal Research Center at the Cleveland Clinic, and colleagues randomly assigned 152 patients with PJI after total joint arthroplasty to undergo either two-stage exchange arthroplasty (n = 76, control group) or a rapid 7-day exchange arthroplasty with intra-articular antibiotic irrigation (n = 76, experimental group). Study endpoints included the Musculoskeletal Infection Society tiers of success divided into tier 1, tier 2 and tier 3, according to Piuzzi.
“When we compared tier 1, and tier 1 and tier 2 combined, we had a 41% higher success rate at 6 months with the interventional experimental arm compared to the control and 23% when we combined both at 6 months,” Piuzzi said in his presentation at the Musculoskeletal Infection Society Annual Meeting.
Statistical significance for outcomes was reached for tier 1 and tier 2 at 6 months, and patients had no differences in the number of treatment errors, according to Piuzzi. He added patients in the experimental group had a shorter total surgery time by 60 minutes compared with the control group.
“The percentage of patients who completed stage-two reimplantation was 100% in the experimental [group and was] 75% in the control group,” Piuzzi said.
Mean time to reimplantation was 7 days in the experimental group vs. 102 days in the control group, according to Piuzzi. He said 22% of patients in the experimental group and 45% of patients in the control group were on antibiotics.
“The mean days in treatment for the experimental arm was 105 days and for the control was 161 days,” Piuzzi said. “The mean number of days that patients were in the success side of it was 63 in the experimental [group] and 5 in the control [group].”
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Springer BD, et al. Paper 1341. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 2-3, 2024; Durham, North Carolina (hybrid meeting).
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