2025 AAOS Annual Meeting: Success of Seven-Day Intra-Articular Antibiotic Irrigation for the Treatment of Chronic Periprosthetic Joint Infection: 12-Month Results from Two Prospective Randomized Comparative Studies.

Ninety-three patients with periprosthetic joint infection were randomized to receive either rapid 7-day exchange arthroplasty with intra-articular antibiotic irrigation (n=46) or standard two-stage exchange arthroplasty (n=47). The primary outcome of interest was treatment success at 12 months, defined as survival, absence of recurrent PJI, no re-operation on the index joint, completion of Stage 2 surgery with a permanent implant, and no antibiotic use. Secondary outcomes included rate of permanent implant placement, time to reimplantation, incidence of septic failure, reoperation, and death. Outcomes were assessed up to 12 months following Stage 1 surgery. Overall, the results of the study revealed a higher proportion of Experimental patients received a permanent implant (100% vs 87.2%; p<0.01) and had significantly shorter time to reimplantation (7 vs 106 days; p<0.01), though the difference in overall treatment success did not reach statistical significance (58% vs 49%; p=0.39). These findings suggest that rapid exchange with intra-articular antibiotics may allow earlier reimplantation with comparable safety and potentially improved outcomes.