Reevaluation of surgical strategies for chronic periprosthetic joint infection: a comparison of short-term outcomes between one-stage and two-stage revision

Objective: This study aims to compare the short-term clinical outcomes of one-stage and two-stage revision surgeries for treating chronic periprosthetic joint infection (PJI), addressing the limitations of the prolonged treatment cycle and heavy medical burden associated with two-stage revision, and evaluating the feasibility and effectiveness of one-stage revision as an alternative therapeutic strategy. Methods: This retrospective cohort study included PJI patients who underwent surgical treatment at our orthopedic center from July 2018 to November 2023. Patients were divided into one-stage revision group (n=16) and two-stage revision group (n=27) based on the surgical approach. The primary outcome was the infection control rate at 24 months postoperatively, while secondary outcomes included Harris hip score(HHS), Knee Society Score (KSS), and the incidence of postoperative complications within 90 days. Results: There were no significant differences between the two groups in baseline characteristics. The mean follow-up duration was 29.5 ± 4.5 months. The infection control rate was comparable between one-stage (87.5%, 14/16) and two-stage (88.9%, 24/27) revision (P = 0.89). For hip function, HHS improved from 52.8 ± 6.3 to 85.2 ± 5.1 in the one-stage group and from 55.1 ± 5.9 to 80.4 ± 6.7 in the two-stage group. For knee function, KSS improved from 54.3 ± 6.5 to 84.7 ± 5.8 in the one-stage group and from 56.4 ± 7.0 to 81.2 ± 6.9 in the two-stage group. The one-stage group demonstrated significantly greater functional improvement in both HHS (P = 0.021) and KSS (P = 0.032). Postoperative complication rates were 18.75% (3/16) and 14.81% (4/27), respectively (P>0.05). Conclusion: In PJI patients with clear preoperative pathogen identification, one-stage revision surgery demonstrates comparable infection control rates and safety to two-stage revision after two years of follow-up, with superior joint function recovery. One-stage revision can effectively avoid a second surgery, shorten the treatment cycle, and reduce patient suffering and economic burden, making it an effective treatment option for eligible PJI patients.