The efficacy of a drug holiday test on two-stage revision for infected total knee arthroplasty

Abstract

Background: We compared the clinical efficacy of normal C-reactive protein (CRP) expression (<1.0 mg/dL), with a 2-week drug holiday test (DHT+) and no drug holiday test (DHT−) as a reimplantation criterion, based on subsequent infections after a two-stage revision of a total knee arthroplasty of a periprosthetic joint infection (PJI). Methods: In a 10-year review of 58 patients (mean age: 73.3-years-old; mean follow-up: 46.2 months), there were 31 patients in the DHT− group and 27 patients in the DHT+ group. Primary outcome was recurrent infection rate. Secondary outcomes included length of hospital stay in the revision stage and CRP resurge one day before revision. Results: We reported that the CRP resurge rate in the DHT+ group (0%) was significantly (p = 0.029) lower than that in the DHT− group (16.1%) one day before the revision. The DHT+ group also had a significantly shorter mean length of stay (LOS) in the hospital (9.6 vs 12.7 days, p = 0.015) and a nonsignificantly lower subsequent infection rate (14.8% vs 29%, p = 0.195). Conclusion: We found that disciplined use of DHT as a reimplantation criterion reduced CRP resurges before reimplantation and yielded a shorter LOS afterward. DHT positively affected the subsequent mid-term infection rate after PJI treatment.