Is one-stage revision as effective as two-stage for periprosthetic joint infection?
Periprosthetic joint infection (PJI) is a serious complication after joint replacement, and revision surgery is often needed to cure it. Traditionally, a two-stage revision (removing the implant, treating the infection, then placing a new implant later) has been the standard. One-stage revision (removing and replacing the implant in a single surgery) is less invasive and less costly, but its effectiveness compared to two-stage has been debated. Recent studies suggest that one-stage revision may be just as effective for many patients, with similar infection control and reinfection rates.
What the research says
A 2025 meta-analysis pooled data from 16 studies with over 2,000 patients and found that reinfection rates were actually lower in the one-stage group (10.02%) compared to the two-stage group (14.75%) 7. Another meta-analysis focusing on hip replacements found no statistically significant difference in reinfection rates between the two approaches (odds ratio 1.34, 95% CI 0.92-1.93) 8. A prospective randomized trial also compared the two approaches and included patients with draining sinuses, comorbidities, and resistant organisms, which were often excluded in earlier studies 6. A retrospective cohort study from 2025 reported comparable infection control rates at 24 months: 87.5% for one-stage and 88.9% for two-stage (P = 0.89) 5. However, the evidence is not entirely uniform. The hip meta-analysis found that when there was no clear decision algorithm for choosing the approach, one-stage revision had a significantly higher reinfection rate than two-stage 8. This suggests that patient selection and surgical expertise matter. Overall, the current evidence supports one-stage revision as a viable option for many patients with PJI, but it may not be suitable for everyone.
What to ask your doctor
- Based on my specific infection and overall health, is one-stage revision a safe option for me?
- What are the risks and benefits of one-stage versus two-stage revision in my case?
- How does your experience and the hospital's protocol affect the success of one-stage revision?
- If I have a draining sinus or resistant bacteria, would that change your recommendation?
- What is the expected recovery time and number of surgeries for each approach?
This question is drawn from common patient questions about Orthopedics & Sports Medicine and answered using cited medical research. We do not provide individualized advice.