Outcomes following planned two-stage exchange arthroplasty for periprosthetic joint infections in the United States: a systematic review of the literature.
Publication Title
Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie
Document Type
Article
Publication Date
6-23-2025
Keywords
texas; covenant; lubbock
Abstract
INTRODUCTION: While two-stage exchange arthroplasty is the gold standard for treating periprosthetic joint infections (PJIs), it results in a prolonged treatment period with the potential for complications and non-planned additional procedures, limited joint function during the interstage period, and emotional stress for patients. The primary objective of this systematic literature review was to evaluate outcomes associated with two-stage exchange arthroplasty for treating total hip arthroplasty (THA) and total knee arthroplasty (TKA) PJIs. This literature review analyzed U.S. data on the timing and health consequences associated with the interstage period and outcomes following reimplantation in patients undergoing two-stage exchange arthroplasty.
MATERIALS AND METHODS: A search of U.S. studies published between January 2014 and January 2024 was conducted using PubMed and Embase databases.
RESULTS: Sixty-five studies reporting data on 26,354 patients undergoing two-stage exchange arthroplasty were included. There were 29.0% and 68.6% of patients who underwent THA and TKA respectively, with 2.4% patients not having the affecting joint identified. The mean interstage period was 141.4 ± 74.2 days with 16.9 ± 12.2% patients not re-implanted. The mean infection eradication was 74.2 ± 10.5% and the average reinfection rate was 15.7 ± 7.1%. Complications and additional procedures were common during the interstage and post-implant periods. Only four studies utilized Musculoskeletal Infection Society (MSIS) Outcomes Reporting Tool. Patients undergoing treatment for TKA PJIs had less successful MSIS outcomes compared to those being treated for THA PJIs. This includes a lower rate of infection control (46.0% vs. 65.5%), a higher rate of reoperation, revision, and/or spacer retention (40.6% vs. 25.2%) and a higher death rate (13.4% vs. 9.4%), respectively.
CONCLUSION: Two-stage exchange arthroplasty treatment of PJIs is associated with major morbidity and often requires additional surgical procedures to address complications. The prolonged duration of the interstage period contributes to morbidity and negatively impacts patients' quality of life and increases the risk of mortality.
Area of Special Interest
Orthopedics & Sports Medicine
Specialty/Research Institute
Orthopedics
Specialty/Research Institute
Surgery
Specialty/Research Institute
Infectious Diseases
DOI
10.1007/s00402-025-05955-0
