Single-Stage Revision and Prosthetic Joint Infection Management in Hip Arthroplasty

Overview and Significance

Recent advancements in surgical technique and infectious disease management have brought single-stage revision to the forefront in the treatment of prosthetic joint infections (PJIs). This progressive method enhances surgical workflows through precise diagnostic protocols and carefully selected patient criteria, promoting robust infection control and shorter hospital stays.

By streamlining the treatment course and prioritizing both infection eradication and patient recovery, single-stage revision offers a compelling alternative to traditional two-stage procedures. For specialists in orthopedics and infectious diseases, this method represents a pathway to improved clinical outcomes and more efficient resource utilization.

Efficacy of Single-Stage Revision in Infection Control

Clinical outcomes from comparative studies support the viability of removing infected prosthetic components and reimplanting new ones within the same surgical session. This approach has demonstrated potential to reduce intraoperative risk and expedite recovery.

A recent randomized controlled trial published in the BMJ found that single-stage revision not only matched the infection control outcomes of two-stage procedures but also significantly shortened hospital stays and improved postoperative function. Importantly, this approach reduced the overall surgical burden on patients by eliminating the need for multiple operations.

Additionally, single-stage strategies appear to reduce the incidence of complications associated with prolonged antibiotic therapy and interim prosthesis use, contributing to better short-term results and cost-effectiveness.

Importance of Accurate Diagnosis and Patient Selection

The success of single-stage revision hinges on rigorous diagnostic protocols and appropriate patient selection. Ideal candidates are those without significant immunosuppression, ongoing systemic infection, or extensive soft tissue loss.

Accurate preoperative diagnosis—including culture-positive results and identification of sinus tracts or fistulae—is essential for determining suitability. A systematic review and meta-analysis in BMC Musculoskeletal Disorders emphasized that strict inclusion criteria, combined with intraoperative pathogen-targeted antibiotic strategies, are critical to the success of this approach.

When applied judiciously, single-stage revision minimizes patient risk and reduces the likelihood of persistent or recurrent infection. It also aligns with value-based care initiatives by decreasing hospitalization time and improving long-term outcomes.