The evolution from the two stage to the one stage procedure for biofilm based periprosthetic joint infections (PJI)

A definitive consensus on the optimal limb salvage protocol for infected total joints does not currently exist. Popular, is the two-stage revision which calls for the use of an antibiotic loaded spacer followed by a delayed exchange. Our question is whether single-stage revisions for biofilm based infected arthroplasties results in comparable or possibly better patient outcomes as compared to those reported for two-stage revisions. We retrospectively reviewed 500 cases of one-stage revisions for periprosthetic joint infections (PJI) using dual setup with radical debridement, definitive reconstruction with antibiotic loaded cement and implantation of antibiotic calcium sulfate pellets between the years 2005–2017. The revisions included 351 total knees, 122 hips, 2 hip-femur-knees, 13 shoulders, 10 elbows, and 2 shoulder-humerus-elbows. The patient population had a mean follow-up of 60 months (range: 24 months–14 years) and mean patient age of 61 years old, consisting of 250 males and 250 females. Patient comorbidities were reviewed, classified using McPherson’s staging for PJIs, and compared to the Cierny & Mader classification system. Successful treatment was defined as a joint without recurrence of infection, for a minimum of 2 years, and limb preservation. Based on our findings, one-stage revision of PJIs demonstrates at least as good an infection eradication rate as two-stage revision: 88% vs 85% respectively.