Two-stage revision arthroplasty for periprosthetic joint infection (PJI) requires placement of an antibiotic-loaded cement spacer. The minimum interval between the first and second stage recommended by current guidelines (Musculoskeletal Infection Society criteria) before reimplantation is based on:

• A A fixed six-week waiting period regardless of inflammatory markers
• B Negative wound swab at the time of spacer insertion only
• C Normalisation of serum CRP and ESR AND negative aspiration culture of the spacer-joint space ✓
• D Disappearance of radiological osteolysis on plain films

Explanation

Current evidence and MSIS consensus recommend reimplantation in two-stage revision PJI when both serum inflammatory markers (CRP <10 mg/L, ESR <30 mm/h) have normalised and a preoperative aspiration of the spacer-joint space yields sterile cultures. A fixed six-week interval alone is insufficient, as persistent infection may exist despite time elapsed. Wound swabs at first stage do not predict second-stage success, and osteolysis resolution is not a primary decision criterion. Meeting the serological and microbiological thresholds significantly reduces re-infection rates.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.