1.5-Stage Revision for the Treatment of Periprosthetic Joint Infection: A Systematic Review

Although the two-stage exchange is the gold standard for the treatment of periprosthetic joint infection (PJI) in the United States, there is recent data to suggest that the utilization of a well-functioning destination spacer, also known as a "functional" or "1.5-stage revision," can be a viable treatment option in patients who have a PJI. The purpose of this systematic review was to evaluate the outcomes of patients undergoing a 1.5-stage revision for PJI and compare outcomes to a two-stage revision.

A systematic review was performed through PubMed, Scopus, and Embase databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed utilizing two reviewers. Following exclusions, 13 studies (n = 924 patients, 704 knees and 228 hips) were identified and included. A standardized template was utilized to capture demographic information (age, body mass index [BMI]), success/failure rate, mean follow-up time (years), and infection-free survivorship compared to two-stage revision. There were 556 patients (428 knees and 136 hips) who had 1.5-stage revisions included in the analyses. The mean age and body mass index were 65 years (range, 60 to 78) and 31 (range, 23.7 to 34.4), respectively.

At a mean follow-up time of 3.8 ± 1.1 years, the mean success rate was found to be 86.8%. The mean failure rate due to infection was 12.6%. In one study, infection-free survivorship was greater in the 1.5-stage revision cohort when compared to the two-stage revision cohort (94 versus 83%, P = 0.048). The remaining five studies that evaluated infection-free survivorship found no significant difference. However, there was a trend toward decreased the 90-day pain scores, postoperative complications, and cost in the 1.5-stage cohort.

Our systematic review demonstrated that a 1.5-stage revision is a viable and cost-effective treatment option for patients who have PJI. Infection-free survivorship was similar or greater when comparing a 1.5-stage revision to a two-stage revision. A 1.5-revision was associated with lower 90-day pain scores, postoperative complications, and decreased cost when compared to the two-stage revision in short-term follow-up, defined as less than five years. To better describe the procedure, we propose the name change to semipermanent eluting antibiotic revision procedure.

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