One Stage Versus Two Stage For Periprosthetic Hip And Knee Infection

Inclusion Criteria: * Patients \>18 years old * Patients who speak English and are willing to sign the consent form * Patients with chronic infection of a total knee or total hip arthroplasty, defined as: * A sinus communicating with the prosthesis * Two positive cultures obtained from the prosthesis * 3 of 5 criteria: (i) Elevated erythrocyte sedimentation rate (ESR) (\>30mm/jr) and c-reactive protein (CRP) (\>10mg/L) (ii) Elevated synovial leukocyte count (\>3000 cells/µL) or change of ++ on leukocyte esterase strip (iii) Elevated synovial neutrophil percentage (\>80%) (iv) One positive culture (v) Positive histological analysis of periprosthetic tissue (\>5 neutrophils per high power field in 5 high power fields x400) * Patients with a previous irrigation and debridement for periprosthetic infection Exclusion Criteria: * Culture negative infections whereby the infecting organism has not identified * Patients with systemic sepsis who require emergent surgery * Patients with extensive soft tissue involvement that would preclude the closure of the wound after reimplantation, if the patient were to undergo the one-stage exchange * Patients with acute PJI or acute hematogenous PJI, defined as: * Presentation of systems \<4 weeks from index procedure * Presentation of systems \<4 week duration * Fungal infections * Resistant organisms not sensitive to available IV antibiotics, oral antibiotics, or heat stable antibiotic additives to bone cement with documented elu…