Evidence brief
Two-Stage Exchange Arthroplasty for Chronic Periprosthetic Hip and Knee Infection
Established two-stage exchange as gold standard for chronic PJI
First stage: explant, debridement, antibiotic spacer
6 weeks minimum antibiotic therapy
Second stage: reimplantation when infection controlled
Success rates 80-90% in subsequent studies
Two-stage exchange remains the gold standard for chronic periprosthetic joint infection, particularly for difficult organisms and patients with poor soft tissues. One-stage is emerging for select cases.
Know indications for two-stage (chronic, resistant organisms, sinus tract, poor soft tissues) vs one-stage (acute, sensitive organism, good soft tissues). Describe spacer types (static vs articulating), antibiotic choice (heat-stable: vancomycin, tobramycin), and reimplantation criteria.
Insall JN, Thompson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am. 1983;65(8):1087-1098.
Level IV
Case series or case reports