Benefits and Adverse Events Associated With Extended Antibiotic Use in Total Knee Arthroplasty Periprosthetic Joint Infection

Abstract

Background: Total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can be managed with debridement, antibiotic therapy, and implant retention (DAIR). Oral antibiotics can be used after DAIR for an extended time period to improve outcomes. The objective of this study was to compare DAIR failure rates and adverse events between an initial course of intravenous antibiotic therapy and the addition of extended treatment with oral antibiotics.

Methods: A multicenter observational study of patients diagnosed with a TKA PJI who underwent DAIR was performed. The primary outcome of interest was the failure rate derived from the survival time between the DAIR procedure and future treatment failure.

Results: One hundred eight patients met inclusion criteria; 47% (n = 51) received an extended course of oral antibiotics. These patients had a statistically significant lower failure rate compared to those who received only intravenous antibiotics (hazard ratio, 2.47; P = .009). Multivariable analysis demonstrated that extended antibiotics independently predicted treatment success, controlling for other variables. There was no significant difference in failure rates between an extended course of oral antibiotics less or more than 12 months (P = .23). No significant difference in the rates of adverse events was observed between patients who received an initial course of antibiotics alone and those who received a combination of initial and extended antibiotic therapy (P = .59).

Conclusions: Extending therapy with oral antibiotics had superior infection-free survival for TKA PJI managed with DAIR. There was no increase in adverse events, demonstrating safety. After 1 year, there appears to be no significant benefit associated with continued antibiotic therapy.

Keywords: adverse events; antibiotics; arthroplasty; periprosthetic joint infection.

Figure 1.

Total knee arthroplasty periprosthetic joint infection debridement, antibiotic therapy, and implant retention (DAIR) survival with acute vs extended antibiotics. The Kaplan-Meier survival curves of DAIR procedures are shown between groups that received only acute antibiotics as compared to chronic suppressive antibiotics with 95% confidence intervals (CIs) (A) and 84% CIs (B). Areas of the curve that do not overlap at an 84% CI suggest statistical significance.

Figure 2.

Kaplan-Meier survival for total knee arthroplasty periprosthetic joint infection debridement, antibiotic therapy, and implant retention (DAIR) of the entire combined cohort.

Figure 3.

Kaplan-Meier survival for total knee arthroplasty periprosthetic joint infection debridement, antibiotic therapy, and implant retention (DAIR) among patients who received chronic suppressive antibiotics.