A Novel Seven-Day Abbreviated Two-Stage Exchange Arthroplasty with Intra-Articular Antibiotic Irrigation for Chronic Periprosthetic Joint Infection of the Knee: A Case Report.

The current standard for treating chronic periprosthetic joint infection (PJI) in North America, a two-stage exchange arthroplasty, has success rates of 65-90% but involves prolonged interstage periods, increased morbidity, and a high 5-years mortality rate of up to 25%. These limitations have driven research into alternative approaches, such as intra-articular antibiotic (IAA) irrigation, which uses a specialized titanium spacer for localized antibiotic delivery over a 7-day period. A 53-year-old male with chronic PJI of the left knee underwent a novel rapid two-stage exchange arthroplasty using an IAA irrigation system. The first stage involved implant removal and placement of a specialized antibiotic delivery IAA device. During the 7-day interstage period, high-concentration local antibiotics (tobramycin and vancomycin) were administered. The second stage, performed 1 week later, included reimplantation with a total stabilized revision knee system. At 1-year post-surgery, the patient demonstrated excellent functional recovery, pain-free mobility, and no signs of recurrent infection. This case illustrates the potential of IAA in managing chronic PJI, offering rapid reimplantation and effective infection control. While promising, larger studies are needed to establish long-term efficacy and cost-effectiveness of this innovative approach.