Long-term outcomes of single-stage versus two-stage revision for prosthetic joint infection: a retrospective,...

To compare long-term outcomes of single-stage and two-stage revision procedures for prosthetic joint infection (PJI) in total joint arthroplasty, with a focus on infection clearance and treatment failure rates in demographically similar patient cohorts. # Methods A retrospective cohort study was conducted at a tertiary referral centre between 2011 and 2021. Patients who underwent either single-stage or two-stage revision for PJI and completed a minimum of two years of follow-up were included. They were identified from electronic health records and hospital databases. Infection clearance at final follow-up was the primary outcome. Treatment failure was defined as need for further revision or long-term suppressive antibiotics.

A total of 75 patients were included, with 50 undergoing single-stage revision and 25 undergoing two-stage revision. The groups were similar for age, joint type and MacPherson host grade. Mean follow-up was 4.2 years (range 2-9). Infection clearance was achieved in 48 patients (96%) in the single-stage group and 23 patients (92%) in the two-stage group (p = 0.624). Treatment failure occurred in two patients (4%) in the single-stage group and in two patients (8%) in the two-stage group. Patients in the single-stage group received significantly longer courses of post-operative antibiotics (mean 6.2 weeks vs 4.8 weeks; p= 0.0058). All-cause 5-year and 10-year mortality was similar between groups (p=0.85).

In patients with chronic PJI and similar demographic profiles, selected patients undergoing single-stage revision demonstrated comparable infection clearance and mortality compared with two-stage revision. These findings support the increasing use of single-stage revision in appropriately selected patients.