Vol.:(0123456789) 1 3 Archives of Orthopaedic and Trauma Surgery https://doi.org/10.1007/s00402-018-3052-4 ORTHOPAEDIC SURGERY Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study Tobias Winkler 1,2,3,4  · Malte G. W. Stuhlert 1,4  · Elke Lieb 1,4  · Michael Müller 1,4  · Philipp von Roth 1,4  · Bernd Preininger 1,4  · Andrej Trampuz 1,3,4  · Carsten F. Perka 1,4 Received: 13 July 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Introduction A two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6–8 week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the infuence of a short (< 4 weeks) and long (≥ 4 weeks) interval on reinfection rate and functional outcome of hip and knee PJI. Methods In this prospective cohort, patients undergoing two-stage revision for PJI were assigned to prosthesis reimplanta- tion after a short (< 4 weeks) or long (≥ 4 weeks) interval. All patients received standardized antimicrobial therapy, which consisted of antibiogram-adapted, non-bioflm-active antibiotics during the interval and an antimicrobial combination therapy with bioflm-active antibiotics after reimplantation. Follow-up was performed for infection, joint function, pain, need for care and quality of life. Results Thirty-eight patients undergoing two-stage revision for PJI (18 hips and 20 knees) were included. Short interval was used in 19 patients having a mean interval of 17.9 days (range 7–27 days), long interval in 19 patients having a mean interval of 63.0 days (range 28–204 days). At a mean follow-up of 39.5 months (range 32–48 months), 37 of 38 patients (97.4%) were infection-free. One failure occurred among patients with long interval and none among patients with short interval. Functional results (ROM, HHS, KSS, VAS) and quality of life (SF-36) were similar in both groups. Patients treated with long interval required cumulatively additional 204 inpatient days for nursing care compared to patients with short interval. Conclusions This study suggests that two-stage exchange with short interval has a similar outcome than with long interval, when highly active antibiotic therapy is used. Patient inconvenience and care costs due to immobilization were lower when strategies with a short interval were used. Keywords Periprosthetic joint infection · Two-stage revision · Interval length · Hip arthroplasty · Knee arthroplasty · Infection management Introduction With an increasingly aged population, the number of arthro- plasties is expected to further rise in industrialized nations, accompanied by a growing number of periprosthetic joint infections (PJI) [6, 22]. Improved diagnostic methods and standardized defnition criteria cause further increase in the infection rates [27, 30]. Two-stage prosthesis exchange is currently the most commonly used surgical procedure for PJI. The reimplantation of the prosthesis is typically per- formed after an interval of 6–8 weeks [5, 11, 23]. However, the optimal length of the prosthesis-free interval remains unknown and has not been systematically compared. We hypothesized that the prosthesis-free interval may be * Tobias Winkler tobias.winkler@charite.de 1 Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany 2 Julius Wolf Institute, Berlin, Germany 3 Berlin-Brandenburg Centre for Regenerative Therapies, Berlin, Germany 4 Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany