The efficacy of a drug holiday test on two-stage revision for infected total knee arthroplasty

Chang, Chun-Hung; Tsai, Shi-Chun; Hsu, Kuei-Hsiang; Chang, Ming-Chau; Chen, Wei-Ming; Su, Yu‐Ping

doi:10.1097/jcma.0000000000000055

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…10,12,13 A drug holiday test of two weeks before implantation has been reported to reduce the rate of recurrence of infection. 14,15 The implementation of the same in our series possibly contributed to good outcomes. Intra-operative testing for bacteria was not done in our series due to possibility of sampling errors, and poor reliability of Gram stain after a course of antibiotics and frozen section being inconclusive.…”

Section: Discussionmentioning

confidence: 65%

Successful two-stage primary total knee arthroplasty for infective arthritis of the knee – our experience

Supreeth

Ghanami

Shanmugasundaram³

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: The incidence of septic arthritis is 2e10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection. Patients and methods: Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation. Discussion: With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same. Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2 nd stage reducing hospital stay, morbidity, and cost. Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection. Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information. Conclusion: All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.

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Section: Discussionmentioning

confidence: 65%

Successful two-stage primary total knee arthroplasty for infective arthritis of the knee – our experience

Supreeth

Ghanami

Shanmugasundaram³

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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“…At least two weeks of intravenous therapy was usually performed, followed by a minimum of four weeks of oral therapy. Antibiotic therapy was discontinued for two weeks if clinical and serum signs were negative for infection 19 , 20 . If clinical and serum negativity for infection was confirmed after about 3–4 months, reimplantation was performed.…”

Section: Methodsmentioning

confidence: 99%

Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

Cacciola

Giustra

Bosco

et al. 2023

Journal of Clinical Orthopaedics and Trauma

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“…This is reinforced by two original cohort studies published in 2019 that reported favorable results without an antibiotic-free period before re-implantation[ 14 , 15 ]. Chang et al [ 16 ] supported this view, finding no statistically significant differences between groups that had an antibiotic break and those that did not.…”

Section: To the Editormentioning

confidence: 99%

Is there sufficient evidence to support the use of antibiotic holiday just before the second stage of an infected total hip or knee arthroplasty revision surgery?

Tsikopoulos,

Sidiropoulos

2024

World J Orthop

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The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach, as per the International Consensus Meeting 2018 on Musculoskeletal Infection. A greater understanding of this issue could augment the quality of Alrayes and Sukeik’s mini-review (2023) on diagnosing, managing, and treating periprosthetic knee infections. However, a significant lack of literature exists concerning the optimal duration for the antibiotic holiday, calling for more research before establishing any clinical guidelines.

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The efficacy of a drug holiday test on two-stage revision for infected total knee arthroplasty

Cited by 3 publications

References 24 publications

Successful two-stage primary total knee arthroplasty for infective arthritis of the knee – our experience

Successful two-stage primary total knee arthroplasty for infective arthritis of the knee – our experience

Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

Is there sufficient evidence to support the use of antibiotic holiday just before the second stage of an infected total hip or knee arthroplasty revision surgery?

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