Optimal Duration of Antibiotic Holiday Before Reimplantation in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: Systematic Review and Meta-analysis.

INTRODUCTION Two-stage exchange arthroplasty is commonly used for the management of chronic periprosthetic joint infection (PJI). Along with many other aspects of this technique, the optimal duration of antibiotic holiday during the interstage period remains contentious. We aimed to answer this question through a systematic review and meta-analysis by synthesizing evidence from the current literature.

METHODS Systematic review was conducted for studies reporting on two-stage exchange arthroplasty for the management PJI in total hip or total knee arthroplasty (TKA) published between January 1, 2013 and May 1, 2024. The meta-analysis included 14 studies reporting outcomes of two-stage exchange arthroplasty with antibiotic holidays for the treatment of chronic PJI following primary total hip arthroplasty or TKA, and the proportion of failed cases were analyzed using prediction models.

RESULTS The pooled proportion of failed cases across studies of any length for antibiotic holiday was 18% (95% confidence interval [CI], 0.16 to 0.20). The proportion of failed cases in studies using an extended duration antibiotic holiday was 18% (95% CI, 0.16 to 0.20) versus 18% (95% CI, 0.15 to 0.23) for studies using a short duration.

CONCLUSION With the number available, the findings identified no notable difference in treatment failure rates with short (<2 weeks) or extended (≥2 weeks) antibiotic holiday duration between the two stages. However, the evidence is limited by substantial heterogeneity among studies, and further studies are necessary to appropriately address this topic.