Effective single- stage revision using intra- articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection

Aims Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection rep-resent a huge challenge for surgeons because of poor vascular supply and biofilm forma- tion. This study aims to determine the results of single -stage revision using intra-articular antibiotic infusion in treating this condition. Methods A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single -stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had un-dergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two -stage revi-sion, and four had a failed one -stage revision before their single -stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intra- venous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated. Results A total of 68 patients (87.1%) were free of infection at a mean follow -up time of 85 months (24 to 133). The seven -year infection -free survival was 87.6% (95% confidence interval (CI) 79.4 to 95.8). No significant difference in infection -free survival was observed between hip and knee PJIs (91.5% (95% CI 79.9 to 100) vs 84.7% (95% CI 73.1 to 96.3); p = 0.648). The mean postoperative Harris Hip Score was 76.1 points (63.2 to 92.4) and Hospital for Special Surgery score was 78. 2 (63.2 to 92.4) at the most recent assessment. Polymicrobial and fungal infections accounted for 14.1% (11/78) and 9.0% (7/78) of all cases, respectively. Conclusion Single -stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid, thereby overcoming reduced vascular supply and biofilm formation. This supplementary route of administration may be a viable option in treating PJI after multiple failed prior surgeries for reinfection.