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Peer-reviewedCC BYArthroplasty (London, England)

Intra-articular antibiotic delivery combined with one-stage revision for periprosthetic joint infection: a systematic review.

  • Xinyue Chang1
  • Michelle Hilda Luk2
  • Amy Cheung2
  • Lawrence Chun Man Lau3
  • Thomas Ka Chun Leung2
  • Henry Fu3
  1. 1Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China. [email protected].
  2. 2Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China.
  3. 3Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
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Abstract

Background

Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty requiring surgical and antibiotic management. One-stage revision has gained attention because it reduces the number of procedures while yielding acceptable outcomes. Intra-articular (IA) antibiotic delivery has been investigated to enhance local antimicrobial exposure and address biofilm-related challenges. However, a focused systematic review of IA antibiotic delivery combined with one-stage revision for PJI is lacking. This systematic review evaluated the techniques, safety, and outcomes of this strategy.Methods

A literature search was conducted up to 30 November 2025 across PubMed (including MEDLINE), Web of Science, Embase, and the Cochrane Library. Studies enrolling adults with PJI treated by one-stage revision combined with IA antibiotic delivery and reporting clinical outcomes with at least 12 months of follow-up were included. Study characteristics, treatment protocols, outcomes, and safety data were extracted and descriptively synthesized.Results

Ten studies were identified. IA antibiotic delivery combined with one-stage revision showed satisfactory infection-control outcomes across individual studies. Antibiotics were selected according to microbiological findings and administered via catheter infusion or direct intra-articular injection for 14-42 days. Reported complications were descriptively summarized and included catheter-related, local, surgical, and systemic adverse events. Renal-related adverse events were reported, with no documented long-term renal impairment in the included studies. Heterogeneity in treatment protocols and study designs was noted across studies.Conclusion

Intra-articular antibiotic delivery combined with one-stage revision for PJI was associated with satisfactory reported infection-control outcomes and safety findings. While the current evidence is largely retrospective and heterogeneous, further prospective comparative studies with standardized protocols would help clarify its clinical role.

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Cite

BibTeXRIS
BibTeX
@article{chang2026intraarticular,
  title = {{Intra-articular antibiotic delivery combined with one-stage revision for periprosthetic joint infection: a systematic review.}},
  author = {Xinyue Chang and Michelle Hilda Luk and Amy Cheung and Lawrence Chun Man Lau and Thomas Ka Chun Leung and Henry Fu},
  journal = {Arthroplasty (London, England)},
  year = {2026},
  month = oct,
  doi = {10.1186/s42836-026-00440-4},
  url = {https://europepmc.org/article/MED/42875813},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Intra-articular antibiotic delivery combined with one-stage revision for periprosthetic joint infection: a systematic review.
AU  - Xinyue Chang
AU  - Michelle Hilda Luk
AU  - Amy Cheung
AU  - Lawrence Chun Man Lau
AU  - Thomas Ka Chun Leung
AU  - Henry Fu
PY  - 2026
DA  - 2026/10/15
JO  - Arthroplasty (London, England)
DO  - 10.1186/s42836-026-00440-4
UR  - https://europepmc.org/article/MED/42875813
AB  - Background  Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty requiring surgical and antibiotic management. One-stage revision has gained attention because it reduces the number of procedures while yielding acceptable outcomes. Intra-articular (IA) antibiotic delivery has been investigated to enhance local antimicrobial exposure and address biofilm-related challenges. However, a focused systematic review of IA antibiotic delivery combined with one-stage revision for PJI is lacking. This systematic review evaluated the techniques, safety, and outcomes of this strategy.Methods  A literature search was conducted up to 30 November 2025 across PubMed (including MEDLINE), Web of Science, Embase, and the Cochrane Library. Studies enrolling adults with PJI treated by one-stage revision combined with IA antibiotic delivery and reporting clinical outcomes with at least 12 months of follow-up were included. Study characteristics, treatment protocols, outcomes, and safety data were extracted and descriptively synthesized.Results  Ten studies were identified. IA antibiotic delivery combined with one-stage revision showed satisfactory infection-control outcomes across individual studies. Antibiotics were selected according to microbiological findings and administered via catheter infusion or direct intra-articular injection for 14-42 days. Reported complications were descriptively summarized and included catheter-related, local, surgical, and systemic adverse events. Renal-related adverse events were reported, with no documented long-term renal impairment in the included studies. Heterogeneity in treatment protocols and study designs was noted across studies.Conclusion  Intra-articular antibiotic delivery combined with one-stage revision for PJI was associated with satisfactory reported infection-control outcomes and safety findings. While the current evidence is largely retrospective and heterogeneous, further prospective comparative studies with standardized protocols would help clarify its clinical role.
SN  - 2524-7948
ER  -