SINGLE-STAGE VERSUS TWO-STAGE ARTHROPLASTY FOR END-STAGE NATIVE JOINT ARTHRITIS WITH SEPTIC ARTHRITIS

Introduction & Aim End-stage native joint arthritis complicated by septic arthritis (SA) remains a major clinical challenge. While two-stage arthroplasty (TSA) is the current standard of care, single-stage arthroplasty (SSA) may offer distinct advantages. This study compared infection control, functional recovery, hospital stay, costs, and complications between TSA and SSA in this patient population. Methods Between May 2018 and March 2023, 23 adults (12 males, 11 females; mean age 61.0±12.3 years) with end-stage knee/hip arthritis and culture-confirmed SA were included. The first 13 patients (11 knees, 2 hips) underwent TSA: 5 with Gachter I-III knee SA received arthroscopic debridement; 6 with Gachter IV knee SA and 2 with hip SA received open debridement (6 received antibiotic-loaded cement spacers). All underwent second-stage arthroplasty after infection eradication. The subsequent 10 patients (5 knees, 5 hips) underwent SSA with thorough intraoperative debridement, instrument change, and immediate prosthesis implantation. All patients received 3 months of postoperative antibiotics (intravenous then oral); SSA patients additionally received intra-articular infusion. Outcomes included infection recurrence, functional scores (Hospital for Special Surgery [HSS] knee score, Knee Society Score [KSS], Harris Hip Score [HHS]), hospital stay, costs, and complications. Results Mean follow-up was 64.8±11.2 months for TSA and 32.8±5.2 months for SSA. No infection recurrence occurred in either group. Both groups showed significant improvements in all functional scores (all p<0.05), with no significant between-group differences in final scores (all p>0.05). SSA had significantly shorter hospital stay (18.1±6.4 vs. 36.7±11.9 days, p<0.001) and lower costs (¥54,712±15,678 vs. ¥80,020±36,367, p<0.001). Deep vein thrombosis (DVT) occurred in 2 SSA patients (isolated calf veins) and 9 TSA patients (multiple vein types; p=0.036). One SSA patient had minor non-infectious wound issues; one TSA patient required manipulation under anesthesia for stiffness. No other complications differed significantly. Conclusions For end-stage native joint arthritis with SA, SSA achieves equivalent infection control and functional outcomes as TSA, while significantly reducing hospital stay, costs, and DVT risk. SSA is a favorable alternative to the standard two-stage approach.