Abbreviated Protocol for Two-Stage Exchange (APEX)

This is an interventional treatment trial for Prosthetic Joint Infection focused on measuring Hip, Knee, Biofilm, Minimum-biofilm-eradication-concentration Read More

Inclusion Criteria:

• Scheduled for two-stage exchange arthroplasty due to hip or knee PJI
• Signed informed consent
• 22 to 84 years of age (inclusive)
• Medical clearance for surgery
• Preoperative diagnosis of PJI of the hip or knee per the International Consensus Meeting of Musculoskeletal Infection (ICMMI) 2018 definition of Periprosthetic Hip and Knee Infection

Exclusion Criteria:

• Patients with 2 or more prior one-stage or two-stage exchange arthroplasties of the infected joint;
• Patients with acute PJI, defined as total joint arthroplasty surgery within 4 weeks prior to enrollment (Stage 1) in this study;
• Patients with bacteremia or positive bacterial blood culture in the last 30 days;
• Patients with concurrent PJI of more than one joint;
• Patients with ongoing active infection of an intravenous (IV) site;
• Patients who require long-term anticoagulation or antiplatelet therapy, and for whom bridging or withholding therapy is not recommended based on the individual's clinical condition;
• Patients with advanced renal insufficiency (chronic kidney disease (CKD) Stage 4 or greater or glomerular filtration rate (GFR) <30 mL/min);
• Patients on chemotherapy for malignant disease;
• Patients on systemic glucocorticoid therapy (prednisone >10 mg/day or equivalent);
• Patients with immunodeficiency (e.g., splenectomy, sickle cell anemia, Stage 3 human immunodeficiency virus (HIV) infection, primary immunodeficiency disease, except immunodeficiency due to immunosuppressive therapy.
• Patients who have an allergy to vancomycin HCl or tobramycin sulfate (Note: prior history of red man syndrome is not considered an allergy);
• Patients who have an allergy to titanium, titanium alloys, polymethylmethacrylate or polyurethane.
• Patients who are pregnant or planning to become pregnant in the next 12 months;
• Patients in whom NPWT is contraindicated;
• Patients with a fungal PJI;
• Patients who have a skeletal defect greater than 150 mm in length in the tibia or femur of the infected joint;
• Patients who have a planned surgical procedure within 6 months of enrollment that can impact the conduct of the study;
• Patients who are breastfeeding at the screening visit;
• Patients who are incarcerated or are facing impending incarceration;
• Patients who have been in treatment or referred for treatment for substance abuse within the past year;
• Patients with any medical condition, including schizophrenia or another psychiatric disorder with hallucinations and/or delusions, that would interfere with the interpretation of the study results, the conduct of the study, or patient participation would not be in the best interest of the patient in the opinion of the Study Site PI;
• Patients who will participate in another clinical study of an investigational drug or investigational device or have participated in another clinical study of an investigational drug or investigational device within the past 30 days that would interfere with the interpretation of the study results or conduct of the study;
• Patients who are judged by the Investigator to be unsuitable for the study.
• Patients receiving immunosuppressive drug therapy for bone marrow or another transplant;
• Patients currently or previously enrolled in this study;
• Patients who receive therapy including any of the following biologic agents, which will not be withheld for a period beginning at least one dosing cycle (minimum 7 days) prior to Stage 1 surgery and ending at least 14 days following Stage 2 surgery:

Adalimumab (Humira) Tocilizumab (Actemra) Etenercept (Enbrel) Anakinra (Kineret) Golimumab (Simponi) Secukinimab (Cosentyx) Infliximab (Remicade) Ustekinumab (Stelara) Abatacept (Orencia) Rituximab (Rituxan) Certolizumab (Cimzia) Tofacitinib (Xeljanz) Belimumab (Benlysta)