A 60-year-old diabetic undergoes total knee replacement. Three months later he develops wound breakdown, sinus tract, and pain. ESR 90, CRP 35, synovial WBC 55,000/mm³. Periprosthetic joint infection (PJI) is confirmed. What is the primary treatment for this chronic PJI with implant loosening?
- A Suppressive lifelong oral antibiotics alone
- B Two-stage revision: prosthesis removal and antibiotic spacer, then reimplantation after infection eradication ✓
- C Irrigation and debridement with polyethylene exchange (DAIR)
- D Single-stage revision with immediate new implant placement
Explanation
Chronic PJI (>4 weeks post-arthroplasty) with implant loosening requires two-stage revision as the standard of care in most guidelines. Stage 1 involves explantation of the infected prosthesis, thorough debridement, and placement of an antibiotic-loaded cement spacer (usually with vancomycin ± gentamicin) to maintain joint space and provide local bactericidal concentrations. After 6 weeks of systemic antibiotics and infection eradication (normalised inflammatory markers, negative aspiration), Stage 2 reimplants a new prosthesis. DAIR is used for acute early PJI with stable implants; single-stage revision is appropriate in selected cases with low-virulence organisms and good soft tissue.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.