Single-Stage Revision Arthroplasty for Infection-An Underutilized Treatment Strategy

Abstract

Background: The burden of revision arthroplasty surgery for infection is rising as the rate of primary arthroplasty surgery increases. Infected arthroplasty rates are now relatively low, but the sheer increase in volume is leading to considerable patient morbidity and significant increases in costs to the health care system. Single-stage revision for infection is one of the several accepted treatment options, but the indications and results are debated. This review aims to clarify the current evidence.

Methods: MEDLINE/PubMed databases were reviewed for studies that looked at single- or one-stage revision knee or hip arthroplasty for infection.

Results: There is increasing evidence that single-stage revision for infection can control infection and with decreased morbidity, mortality, and health care costs compared with a staged approach. However, the indications are still debated. Recently, there has been a determined effort to define an infected arthroplasty in a manner that will allow for standardization of reporting in the literature. The evidence supporting single stage for knee arthroplasty is catching up with the result with hip arthroplasty. High-quality data from randomized controlled trials are now pending.

Conclusion: After the gradual evolution of using the single-stage approach, with the widespread acceptance of this definition, we can now standardize comparisons across the world and move toward a refined definition of the ideal patient population for single-stage arthroplasty revision in both the hip and the knee population.

Keywords: infected revision; one-stage arthroplasty; periprosthetic infection; septic revision; single-stage arthroplasty.