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

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.