Optimal Duration of Antibiotic Holiday Before Reimplantation in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: Systematic Review and Meta-analysis.
Elizabeth K Carlino, Kyle H Cichos, Craishun Hart et al.
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In 30 seconds
This systematic review and meta-analysis examined whether the duration of the antibiotic-free interval between stages of exchange arthroplasty affects treatment failure in chronic periprosthetic joint infection after primary total hip or knee arthroplasty. Fourteen studies were included. The pooled proportion of failed cases was 18% (95% CI, 0.16 to 0.20). Failure proportions were also 18% in studies using an extended holiday (≥2 weeks; 95% CI, 0.16 to 0.20) and 18% with a short holiday (<2 weeks; 95% CI, 0.15 to 0.23), with no notable difference identified.
Key findings
- Across studies using antibiotic holidays of any duration, the pooled proportion of failed cases was 18% (95% CI, 0.16 to 0.20).
- Failure proportions were 18% with an extended holiday (≥2 weeks; 95% CI, 0.16 to 0.20) and 18% with a short holiday (<2 weeks; 95% CI, 0.15 to 0.23).
- The review identified no notable difference in treatment failure rates between short and extended antibiotic holidays.
Why it matters
The antibiotic-free interval is a debated component of two-stage exchange for chronic periprosthetic joint infection. These pooled findings do not show a lower failure proportion with an extended rather than short holiday, helping frame the uncertainty around this interstage decision. The substantial heterogeneity means the estimates should be interpreted cautiously rather than as proof that the durations are equivalent.
What to keep in mind
The authors report substantial heterogeneity among studies, and the available evidence was insufficient to resolve the question definitively.