Comparative Study of the Efficacy of One-Stage versus Two-Stage Revision for Chronic Periprosthetic Joint Infection Following Total Knee Arthroplasty

Abstract Objective To compare the clinical efficacy, functional recovery, and medical economic burden of one-stage versus two-stage revision for chronic periprosthetic joint infection (PJI) following total knee arthroplasty, and to evaluate the feasibility and effectiveness of one-stage revision as an alternative treatment strategy. Methods This retrospective cohort study enrolled 108 patients with chronic PJI following total knee arthroplasty (TKA-PJI) who underwent surgical treatment at our center between January 2018 and December 2023 and who met the inclusion criteria. Patients were assigned to a one-stage revision group (n = 56) or a two-stage revision group (n = 52) according to the surgical strategy, a grouping that was determined by institutional selection criteria rather than randomization. The primary outcome measure was the infection control rate at a mean postoperative follow-up of 28 months. Secondary outcome measures included the visual analog scale (VAS) score, range of motion (ROM), and the Knee Society Score (KSS). Results Except for total hospitalization costs, baseline characteristics did not differ significantly between the two groups (P > 0.05). At the final follow-up, the infection control rate was 96.4% (54/56) in the one-stage group and 96.2% (50/52) in the two-stage group, with no statistically significant difference between groups (P = 0.981); the relative risk for two-stage versus one-stage revision was 1.08 (95% CI, 0.15–7.96), equivalently 0.93 (95% CI, 0.14–6.36) for one-stage versus two-stage; the absolute risk difference was − 0.3% (95% CI, -8.7% to 8.0%), so the risk of the event cannot be considered different between the two groups. In the early postoperative period, the one-stage group showed a statistically significant but clinically modest advantage in pain control at 14 days after surgery (VAS: 3.1 vs 3.6, P < 0.01) and in ROM recovery at 3 months after surgery (105.8° vs 103.3°, P = 0.026), and this difference did not recur at any other time point. At the final follow-up, however, the KSS was approximately 88 in both groups, with no statistically significant difference (P = 0.426). With regard to medical costs, the total hospitalization cost in the one-stage revision group was significantly lower than that in the two-stage revision group (P < 0.01). Conclusion In this single-center retrospective cohort with a mean follow-up of 28 months, the infection control rate of one-stage revision did not differ statistically significantly from that of two-stage revision, and hospitalization costs were lower. Provided that prerequisites are strictly met—thorough debridement, soft tissue conditions permitting primary closure, and a preoperatively identified pathogen with confirmed antibiotic susceptibility—a sinus tract was amenable to one-stage revision in our experience. In summary, one-stage revision can serve as one of the treatment options for chronic TKA-PJI, but its long-term efficacy still requires confirmation by prospective multicenter studies.