Introduction

• Periprosthetic joint infection (PJI) is a severe complication of joint arthroplasty often requiring

multiple surgeries and prolonged antibiotics.

• Negative pressure wound therapy with instillation (NPWTi-d) combines wound irrigation and

negative pressure to reduce bacteria, improve perfusion, and decrease dead space.

• Two-stage revision remains the gold standard for complex PJIs, but success rates are variable

with frequent recurrence.

• NPWTi-d may improve wound preparation and biofilm disruption before reimplantation, though

its benefit in PJIs is not yet fully proven.

• This study evaluated the impact of NPWTi-d on treatment outcomes and complications in

patients with periprosthetic joint infection (PJI), hypothesizing that its use may influence

complication and success rates.

Methods

A retrospective review of 111 adults with culture-confirmed periprosthetic joint infections

(PJIs) from 2015–2025 was performed.

• 37 patients treated with NPWTi-d therapy were matched 2:1 with 74 controls based on

demographic and clinical factors. Outcomes included infection eradication without recurrence

or reoperation, as well as complication rates. Logistic and negative binomial regression

analyses were used to evaluate factors associated with treatment outcomes.

 

Results

 

Gender distribution, smoking status, type of surgery, polymicrobial status, CCI, age, and BMI

did not differ significantly between groups (p ≥ 0.28). Table 1

• Patients treated with NPWTi-d) underwent a higher number of total surgeries (median 4 vs. 2,

p < 0.001) and received a greater number of antibiotic doses within the spacer (median 3 vs.

1, p = 0.02). Table 1

• Explantation was less frequent in the NPWTi-d) group compared to the non-NPWTi-d) group

(8.1% vs. 24.3%, p = 0.04). Table 1

• Fungal infections were significantly associated with lower odds of treatment success compared with

bacterial infections (OR [Odds Ratio] 0.31, 95% CI [Confidence Interval] 0.11–0.88, p = 0.028).

• Smoking status also demonstrated a strong association: former smokers (OR 8.12, 95% CI 2.02–

32.60, p = 0.003) and never smokers (OR 4.18, 95% CI 1.09–15.99, p = 0.036) had markedly higher

odds of success compared with current smokers.

• Higher CCI scores were negatively associated with treatment success (OR 0.70, 95% CI 0.51–0.96,

p = 0.027).

• A trend toward reduced odds of success was also observed with an increasing number of spacers

(OR 0.58, 95% CI 0.33–1.01, p = 0.054).

• Use of antibiotics in cement was independently associated with an increased number of

complications (coefficient 1.35, 95% CI 0.91–1.80, p < 0.001) demonstrated by negative binomial

regression analysis of complications

• Both higher total number of surgeries (coefficient 0.10, 95% CI 0.02–0.17, p = 0.014) and higher CCI

score (coefficient 0.17, 95% CI 0.05–0.28, p = 0.003) were also significant predictors of increased

complications

• Within the failure group (n = 50), the association between NPWTi-dtreatment and complications was

further evaluated (Table 4). Rates of chronic antibiotic suppression and chronic spacer use did not

differ significantly between patients treated with NPWTi-d) and those without (chronic suppression:

14% vs. 10%, p = 0.67; chronic spacer: 10% vs. 10%, p = 0.92).

• A retrospective review of 111 adults with culture-confirmed periprosthetic joint infections

(PJIs) from 2015–2025 was performed.

• 37 patients treated with NPWTi-d therapy were matched 2:1 with 74 controls based on

demographic and clinical factors. Outcomes included infection eradication without recurrence

or reoperation, as well as complication rates. Logistic and negative binomial regression

analyses were used to evaluate factors associated with treatment outcomes.

Conclusion

8.12 5.76 0.003 2.02 – 32.60

Never 4.18 2.86 0.036 1.09 – 15.99

0.58 0.16 0.054 0.33 – 1.01

Total Number of Spacers

CCI Score (0–37) Post-op Ortho Follow-up (per day)

• NPWTi-d therapy was associated with reduced explantation rates in PJI patients, even though

it was often employed in cases with greater surgical complexity.

• Infection type, smoking status, and comorbidity burden were the strongest determinants of

treatment outcomes.

• While NPWTi-d may serve as an important adjunctive tool in select patients, comprehensive

patient optimization and tailored infection management remain the cornerstones of PJI care.