Can “LITE” Procedure Combined With a Short Course Antibiotic Treatment Be Effective in Treating the Chronic PJI?—A Prospective Randomized Controlled Trial

Abstract

Objective: The prevailing treatment for chronic periprosthetic joint infection (PJI) is a two-stage exchange, yet the optimal duration of antibiotic therapy following this procedure remains a topic of debate. This study aimed to determine whether a short course of postoperative antibiotic therapy can maintain infection control rates following a long interval two-stage exchange (LITE) for PJI.

Methods: We conducted a prospective study enrolling patients with chronic PJI who underwent the LITE procedure at our institution from April 2018 to November 2021. Patients were randomly assigned to receive either a long course (12 weeks) or short course (2 weeks) of postoperative antibiotics. The pathogens, antibiotics, inflammatory markers, antibiotic-related complications, cases of reinfection, or re-operation were recorded. Continuous variables were analyzed using the two-sample t-test or Mann–Whitney U test, and categorical variables were analyzed using Fisher’s exact tests. Kaplan–Meier survival analysis was used to compare infection control rates.

Results: A total of 60 patients with chronic PJI who completed the LITE procedure were included in the study (30 patients per group). All patients were followed for a minimum of 24 months (mean 39.2 ± 13.0 months). We observed that the infection control rate in the short-course group was not inferior to that in the long-course group (96.7% vs. 96.7%, p = 1.000).

Conclusions: For patients with chronic PJI undergoing the LITE procedure, a 2-week course of postoperative antibiotics suffices to maintain infection control rates.

Trial Registration: Chinese Clinical Trial Registry: ChiCTR1900027089

Keywords

course of antibiotic treatment / long interval two-stage exchange / periprosthetic joint infection

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.