Reimplantation in 2-Stage Exchange: Breaking the Dogma of the 2-Week Antibiotic Holiday

➢ The optimal timing for reimplantation in patients with periprosthetic joint infection undergoing 2-stage exchange revision is challenging. The metrics used to determine reimplantation timing, such as serum inflammatory markers and culture results, often have low predictive value and can be misleading or discordant. ➢ A combination of clinical signs indicating infection resolution together with declining serological and synovial markers may be used to guide the timing of reimplantation. ➢ The rationale for an antibiotic holiday is to allow for a persistent infection to “resurface” in that period, prior to reimplantation. ➢ Available data have shown no clear evidence of improved outcomes when an antibiotic holiday is implemented. ➢ However, continuous antibiotic therapy offers important advantages, including a shorter overall treatment duration and higher cure rates, particularly in immunocompromised patients. There is a dire need to develop a tool to guide the optimal timing of reimplantation.