Overview of exchange arthroplasty

Exchange arthroplasty has the highest reported cure rate of all the orthopaedic surgical strategies for arthroplasty device infectionsManning, 2020. Exchange arthroplasty is effective for all classifications of arthroplasty device infections and is usually necessary for late chronic infections. In particular, infections of prosthetic shoulder joints are usually late chronic infections (especially those caused by Cutibacterium acnes) and typically require exchange arthroplasty.

Exchange arthroplasty is usually done in one or two stages, with the two-stage approach being the most commonly used. A two-stage exchange arthroplasty requires multiple operations and may involve prolonged impaired mobility and increased morbidity compared to a one-stage exchange arthroplasty or debridement and implant retention (DAIR).

In patients undergoing exchange arthroplasty, give surgical antibiotic prophylaxis at the usual time before surgical incision—surgical antibiotic prophylaxis should not be delayed until after the collection of peri-prosthetic samples because this increases the risk of further infection at the surgical site.