The intra-articular combined intravenous administration of antibiotics versus intravenous administration of antibiotics in patients with prosthetic joint infection: a prospective, randomized controlled trial

Abstract

Abstract Purpose The purpose of this study was to compare the safety and effectiveness of combined intra-articular and intravenous administration of antibiotics with intravenous administration of antibiotics in patients with periprosthetic joint infection (PJI) undergoing one-stage revision. Methods A prospective study of 52 patients was performed between October 2021 and February 2023.Patients undergoing one-stage revision as the treatment for PJI were randomized into group A (intravenous administration) or group B (combined intra-articular and intravenous administration). All patients receive intravenous antibiotic therapy.Patients with gram-positive bacteria and culture-negative infections in group B received additionally intra-articular administration of 0.5g of vancomycin every morning.For the infections caused by negative bacteria and fungal organisms,a pathogen-sensitive antibiotic was selected for intra-articular administration.The primary outcome was the treatment success rates of both groups at the last final follow-up.The serum inflammatory markers and indicators of kidney and liver function were compared between the two groups on post-admission day 1 and on postoperative days 1, 3, 5, 7, 14, and 21.The Harris Hip Score (HHS), Knee Society Scores (KSS), and activities of daily living (ADL) were compared between the 2 groups. Results With a mean follow-up of 22.19 ± 4.69 months,the success rates of group A (n = 26) and group B (n = 26) were 88.5% and 96.2%, respectively (P = 0.610).At the 21-day time point after surgery, the levels of CRP and ESR were significantly lower in group B than in group A (P < 0.05).There were no statistically significant differences in indicators of kidney and liver function between two groups. The ADL and KSS of group B were higher than those of group A (P < 0.05). Conclusions Combined intra-articular and intravenous administration of antibiotics is an effective treatment for PJI. Compared with intravenous administration of antibiotics therapy, a combination of intra-articular and intravenous administration of antibiotics therapy is a superior means of addressing systemic inflammation and promoting functional recovery.