Chronic Periprosthetic Joint Infection: Two-Stage Exchange

Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. The optimal PJI treatment depends on several factors such as presentation and chronicity of the infection, characteristics of the responsible microorganism, host health status, and overall surgeon/institutional experience Two-stage exchange arthroplasty is the preferred method for treating chronic PJI in North America. The first stage involves thorough debridement and removal of the infected prosthesis, followed by placement of an antibiotic-loaded cement spacer and treatment with targeted systemic antibiotics. Surgeons generally choose between placing either a static or an articulating spacer. Several options for spacer construction exist including spacer molds, preformed constructs, or hand-crafted devices. The second stage involves spacer removal and reimplantation with revision components. The choice of spacer type and design is dependent on several patient and surgeon-related factors. Infection eradication and improved function are the ultimate goals of two-stage exchange arthroplasty. Reported outcomes of this management option are acceptable. However, many important risk factors for treatment failure do exist. This chapter outlines the management of PJI with two-stage exchange arthroplasty with an emphasis on the diagnosis of PJI, surgical indications, surgical technique, and treatment outcomes.