One-Stage Revision for Periprosthetic Hip and Knee Infections: A Multicenter Experience
Article Sidebar
Published:
Oct 27, 2025
Keywords:
Periprosthetic joint infections, hip, knee, one-stage revision
Main Article Content
Abstract
Introduction: Periprosthetic joint infection (PJI) is a devastating complication after hip or knee arthroplasty. Although two-stage revision is considered the treatment of choice for chronic infections, one-stage revision has emerged as an alternative that reduces morbidity.
Objective: To report the results and advantages of one-stage revision for chronic PJI of the hip and knee.
Materials and Methods: Twenty-four patients (16 knees and 8 hips) with PJI, without severe systemic or limb compromise according to McPherson’s classification, were included. All underwent one-stage revision and received intravenous antibiotics for at least 10 days, followed by oral therapy for a minimum of 3 months. Comorbidities, clinical outcomes, and infection control were assessed with a minimum follow-up of 1 year.
Results: Seventy-five percent of patients (18/24) were classified as McPherson host type A, and 91.6% (22/24) had good soft tissue conditions (type I). Infection was controlled in 22 cases (91.6%), while 2 patients had persistent infection. All patients showed improvement in mobility and satisfaction, particularly those treated for knee infections.
Conclusions: One-stage revision achieved good outcomes in most cases of chronic PJI, with a high infection control rate (91.6%). This strategy reduces the morbidity associated with two-stage revision, provided that patients are carefully selected, the causative pathogen is identified, and antibiotic susceptibility is known.
Objective: To report the results and advantages of one-stage revision for chronic PJI of the hip and knee.
Materials and Methods: Twenty-four patients (16 knees and 8 hips) with PJI, without severe systemic or limb compromise according to McPherson’s classification, were included. All underwent one-stage revision and received intravenous antibiotics for at least 10 days, followed by oral therapy for a minimum of 3 months. Comorbidities, clinical outcomes, and infection control were assessed with a minimum follow-up of 1 year.
Results: Seventy-five percent of patients (18/24) were classified as McPherson host type A, and 91.6% (22/24) had good soft tissue conditions (type I). Infection was controlled in 22 cases (91.6%), while 2 patients had persistent infection. All patients showed improvement in mobility and satisfaction, particularly those treated for knee infections.
Conclusions: One-stage revision achieved good outcomes in most cases of chronic PJI, with a high infection control rate (91.6%). This strategy reduces the morbidity associated with two-stage revision, provided that patients are carefully selected, the causative pathogen is identified, and antibiotic susceptibility is known.
Downloads
Download data is not yet available.
Article Details
How to Cite
Martínez, W. F., Bochatey, E. J., & Lopreite, F. A. (2025). One-Stage Revision for Periprosthetic Hip and Knee Infections: A Multicenter Experience. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(5), 417-425. https://doi.org/10.15417/issn.1852-7434.2025.90.5.2145
Section
Clinical Research
Copyright (c) 2025 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Premkumar A, Kolin DA, Farley KX, Wilson JM, McLawhorn AS, Cross MB, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 2021;36(5):1484-1489.e3. https://doi.org/10.1016/j.arth.2020.12.005
2. Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. Are we winning or losing the battle with periprosthetic joint infection: Trends in periprosthetic joint infection and mortality risk for the Medicare population. J Arthroplasty 2018;33(10):3238-45. https://doi.org/10.1016/j.arth.2018.05.042
3. Otto-Lambertz C, Yagdiran A, Wallscheid F, Eysel P, Jung N. Periprosthetic infection in joint replacement. Dtsch Arztebl Int 2017;114(20):347-3. https://doi.org/10.3238/arztebl.2017.0347
4. Bonanzinga T, Tanzi G, Iacono F, Ferrari MC, Marcacci M. Periprosthetic knee infection: two stage revisión surgery. Acta Biomed 2017;88(4S):114-9. https://doi.org/10.23750/abm.v88i4-S.6802
5. Fowler TJ, Sayers A, Whitehouse MR. Two-stage revision surgery for periprosthetic joint infection following total hip arthroplasty. Ann Transl Med 2019;7(Suppl 8):S261. https://doi.org/10.21037/atm.2019.12.126
6. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J 2013;95-B(11 Suppl A):77-83. https://doi.org10.1302/0301-620X.95B11.32646
7. Kendoff D, Gehrke T. Surgical management of periprosthetic joint infection: one-stage Exchange. J Knee Surg 2014;27(4):273-8. https://doi.org/10.1055/s-0034-1376882
8. Nguyen M, Sukeik M, Zahar A, Nizam I, Haddad FS. One-stage exchange arthroplasty for periprosthetic hip and knee joint infections. Open Orthop J 2016;10:646-53. https://doi.org/10.2174/1874325001610010646
9. Zhao Y, Fan S, Wang Z, Yan X, Luo H. Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: a call for a prospective randomized trial. BMC Musculoskelet Disord 2024;25(1):153. https://doi.org/10.1186/s12891-024-07229-z
10. Kildow BJ, Della-Valle CJ, Springer BD. Single vs 2-stage revision for the treatment of periprosthetic joint infection. J Arthroplasty 2020;35(3S):S24-S30. https://doi.org/10.1016/j.arth.2019.10.051
11. Baldini A, Blevins K, Del Gaizo D, Enke O, Goswami K, Griffin W, et al. Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019b;34(2S):S97-S104. https://doi.org/10.1016/j.arth.2018.09.059
12. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 2002;(403):8-15. PMID: 12360001
13. McPherson EJ, Tontz W Jr, Patzakis M, Woodsome C, Holtom P, Norris L, et al. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J Orthop (Belle Mead NJ) 1999;28(3):161-5. PMID: 10195839
14. Wignadasan W, Ibrahim M, Haddad F. One- or two-stage reimplantation for infected total knee prosthesis? Orthop Traumatol Surg Res 2023;109(1S):103453. https://doi.org/10.1016/j.otsr.2022.103453
15. Zahar A, Kendoff DO, Klatte TO, Gehrke TA. Can good infection control be obtained in one-stage exchange of the infected tka to a rotating hinge design? 10-year results. Clin Orthop Relat Res 2016;(474):81-7. https://doi.org/10.1007/s11999-015-4408-5
16. Wolf M, Clar H, Friesenbichler J, Schwantzer G, Bernhardt G, Gruber G, et al. Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange. Int Orthop 2014;38(7):1363-8. https://doi.org/10.1007/s00264-014-2309-y
17. Ji B, Zhang Z, Xu B, Ren J, Guo W, Mu W, et al. The fate of immunocompromised patients in the treatment of chronic periprosthetic joint infection: a single-centre experience. Int Orthop 2018;42(3):487-98. https://doi.org/10.1007/s00264-018-3763-8
18. Zmistowski B, Fedorka CJ, Sheehan E, Deirmengian G, Austin MS, Parvizi J. Prosthetic joint infection caused by gram-negative organisms. J Arthroplasty 2011;26(6 Suppl):104-8. https://doi.org/10.1016/j.arth.2011.03.044
19. Gonzalez MR, Gonzalez J, Patel RV, Werenski JO, Lizcano JD, Lozano-Calderon SA; Gram-negative PJI Collaborative Group. Microbiology, treatment, and postoperative outcomes of Gram-negative prosthetic joint infections-A systematic review of the literature. J Am Acad Orthop Surg 2025;33(6):e327-e339. https://doi.org/10.5435/JAAOS-D-23-01203
20. Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res 2015;473(1):8-14. https://doi.org/10.1007/s11999-014-3721-8
21. Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon YM. Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: A propensity score-matched cohort study. J Arthroplasty 2021;36(1):298-304. https://doi.org/10.1016/j.arth.2020.07.012
22. Vanhegan IS, Morgan-Jones R, Barrett DS, Haddad FS. Developing a strategy to treat established infection in total knee replacement: a review of the latest evidence and clinical practice. J Bone Joint Surg Br 2012;94(7):875-81. https://doi.org/10.1302/0301-620X.94B7.28710
23. Zahar A, Gehrke TA. One-stage revision for infected total hip arthroplasty. Orthop Clin North Am 2016;47(1):11-8. https://doi.org/10.1016/j.ocl.2015.08.004
2. Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. Are we winning or losing the battle with periprosthetic joint infection: Trends in periprosthetic joint infection and mortality risk for the Medicare population. J Arthroplasty 2018;33(10):3238-45. https://doi.org/10.1016/j.arth.2018.05.042
3. Otto-Lambertz C, Yagdiran A, Wallscheid F, Eysel P, Jung N. Periprosthetic infection in joint replacement. Dtsch Arztebl Int 2017;114(20):347-3. https://doi.org/10.3238/arztebl.2017.0347
4. Bonanzinga T, Tanzi G, Iacono F, Ferrari MC, Marcacci M. Periprosthetic knee infection: two stage revisión surgery. Acta Biomed 2017;88(4S):114-9. https://doi.org/10.23750/abm.v88i4-S.6802
5. Fowler TJ, Sayers A, Whitehouse MR. Two-stage revision surgery for periprosthetic joint infection following total hip arthroplasty. Ann Transl Med 2019;7(Suppl 8):S261. https://doi.org/10.21037/atm.2019.12.126
6. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J 2013;95-B(11 Suppl A):77-83. https://doi.org10.1302/0301-620X.95B11.32646
7. Kendoff D, Gehrke T. Surgical management of periprosthetic joint infection: one-stage Exchange. J Knee Surg 2014;27(4):273-8. https://doi.org/10.1055/s-0034-1376882
8. Nguyen M, Sukeik M, Zahar A, Nizam I, Haddad FS. One-stage exchange arthroplasty for periprosthetic hip and knee joint infections. Open Orthop J 2016;10:646-53. https://doi.org/10.2174/1874325001610010646
9. Zhao Y, Fan S, Wang Z, Yan X, Luo H. Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: a call for a prospective randomized trial. BMC Musculoskelet Disord 2024;25(1):153. https://doi.org/10.1186/s12891-024-07229-z
10. Kildow BJ, Della-Valle CJ, Springer BD. Single vs 2-stage revision for the treatment of periprosthetic joint infection. J Arthroplasty 2020;35(3S):S24-S30. https://doi.org/10.1016/j.arth.2019.10.051
11. Baldini A, Blevins K, Del Gaizo D, Enke O, Goswami K, Griffin W, et al. Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019b;34(2S):S97-S104. https://doi.org/10.1016/j.arth.2018.09.059
12. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 2002;(403):8-15. PMID: 12360001
13. McPherson EJ, Tontz W Jr, Patzakis M, Woodsome C, Holtom P, Norris L, et al. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J Orthop (Belle Mead NJ) 1999;28(3):161-5. PMID: 10195839
14. Wignadasan W, Ibrahim M, Haddad F. One- or two-stage reimplantation for infected total knee prosthesis? Orthop Traumatol Surg Res 2023;109(1S):103453. https://doi.org/10.1016/j.otsr.2022.103453
15. Zahar A, Kendoff DO, Klatte TO, Gehrke TA. Can good infection control be obtained in one-stage exchange of the infected tka to a rotating hinge design? 10-year results. Clin Orthop Relat Res 2016;(474):81-7. https://doi.org/10.1007/s11999-015-4408-5
16. Wolf M, Clar H, Friesenbichler J, Schwantzer G, Bernhardt G, Gruber G, et al. Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange. Int Orthop 2014;38(7):1363-8. https://doi.org/10.1007/s00264-014-2309-y
17. Ji B, Zhang Z, Xu B, Ren J, Guo W, Mu W, et al. The fate of immunocompromised patients in the treatment of chronic periprosthetic joint infection: a single-centre experience. Int Orthop 2018;42(3):487-98. https://doi.org/10.1007/s00264-018-3763-8
18. Zmistowski B, Fedorka CJ, Sheehan E, Deirmengian G, Austin MS, Parvizi J. Prosthetic joint infection caused by gram-negative organisms. J Arthroplasty 2011;26(6 Suppl):104-8. https://doi.org/10.1016/j.arth.2011.03.044
19. Gonzalez MR, Gonzalez J, Patel RV, Werenski JO, Lizcano JD, Lozano-Calderon SA; Gram-negative PJI Collaborative Group. Microbiology, treatment, and postoperative outcomes of Gram-negative prosthetic joint infections-A systematic review of the literature. J Am Acad Orthop Surg 2025;33(6):e327-e339. https://doi.org/10.5435/JAAOS-D-23-01203
20. Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res 2015;473(1):8-14. https://doi.org/10.1007/s11999-014-3721-8
21. Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon YM. Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: A propensity score-matched cohort study. J Arthroplasty 2021;36(1):298-304. https://doi.org/10.1016/j.arth.2020.07.012
22. Vanhegan IS, Morgan-Jones R, Barrett DS, Haddad FS. Developing a strategy to treat established infection in total knee replacement: a review of the latest evidence and clinical practice. J Bone Joint Surg Br 2012;94(7):875-81. https://doi.org/10.1302/0301-620X.94B7.28710
23. Zahar A, Gehrke TA. One-stage revision for infected total hip arthroplasty. Orthop Clin North Am 2016;47(1):11-8. https://doi.org/10.1016/j.ocl.2015.08.004