Abstract
BACKGROUND: Periprosthetic joint infection (PJI) is a serious complication that necessitates a complex treatment strategy. Single-stage exchange arthroplasty, combined with intravenous and intra-articular antibiotic infusions, has shown high efficacy in treating complex PJIs. However, the impact of this approach on hematologic parameters remains underexplored. This study aims to evaluate the postoperative trends in blood platelet count, white blood cell (WBC) count, and neutrophil count in patients undergoing single-stage exchange arthroplasty. METHODS: A retrospective analysis was conducted on 313 patients who underwent single-stage revision for PJI between June 2010 and October 2022. Hematologic parameters were monitored for the first seven postoperative days. The delta between preoperative and lowest postoperative values for platelet, WBC, and neutrophil counts was calculated. Statistical analyses compared these changes between revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) groups. RESULTS: Platelet count significantly decreased postoperatively, reaching its nadir on day 2.5 for rTHA and day 2.8 for rTKA. The delta in platelet count was higher in rTHA patients (73.5 × 10(9)/L) compared to rTKA patients (46.0 × 10(9)/L). The incidence of thrombocytopenia was higher in the rTHA group (28.7%) compared to the rTKA group (12.3%). Multivariate regression analysis identified rTHA and preoperative platelet levels as independent risk factors for greater postoperative platelet decreases. WBC and neutrophil counts initially increased postoperatively, peaking on day 1, and then gradually declined, with nadirs around day 4-5. CONCLUSION: Single-stage revision for PJI is associated with significant postoperative decreases in platelet count, particularly in patients undergoing rTHA. However, this hematologic change did not result in bleeding complications and may not represent a major clinical concern in most patients. Routine monitoring remains advisable to guide perioperative management.