Periprosthetic joint infections single-stage revision systematic review: An update to practicing clinicians

Single-stage revision (SSR) is becoming more frequently utilized for the management of periprosthetic joint infections (PJIs) in total hip arthroplasty (THA) and total knee arthroplasty (TKA) for comparable outcomes to two-stage revision. Clinical libraries were searched from January 2019 for studies that investigated the management of SSR for PJIs in hip and knee arthroplasty as a systematic review of outcome measures, techniques, antibiotic duration, absolute contraindications, draping practices, culture-negative infections, fungal infections, PJIs with the presence of a sinus tract, and collateral ligament retention. Four studies (n = 355) demonstrated varied antibiotic strategies, including oral, intravenous, and intra-articular, with reported infection remission rates ranging from 90 to 94.3 %. Seven studies (n = 72) examined SSR outcomes in culture-negative and fungal PJIs, reporting success rates of 72.2 % and 77.8 %, respectively. Three studies (n = 520) recommended dual sterile setups, achieving infection eradication rates comparable to two-stage revision. Nine studies (n = 1208) addressed SSR in patients with the presence of a sinus tract, with success rates ranging from 64 % to 90.5 %. Two studies (n = 299) endorsed collateral ligament preservation during debridement. Seven studies (n = 617) identified contraindications to SSR, including systemic sepsis, extensive soft-tissue or bone loss, neurovascular involvement, unknown pathogens or sensitivities, polymicrobial infection, and inability to achieve primary wound closure. This systematic review provides an update for evidence-based recommendations regarding the management of PJIs in THA and TKA for SSR. SSR has comparable outcomes to two-stage revision for the treatment of most PJIs. CRD42025104.