Can a 1.5-Stage Revision Be an Effective Alternative for Chronic Periprosthetic Hip and Knee Infections? A Systematic Review and Meta-Analysis

Enrico Festa; Tiziana Ascione; Domenico De Mauro; Donato Di Gennaro; Andrea Baldini; Giovanni Balato

doi:10.1016/j.arth.2024.09.024

Can a 1.5-Stage Revision Be an Effective Alternative for Chronic Periprosthetic Hip and Knee Infections? A Systematic Review and Meta-Analysis

J Arthroplasty. 2024 Sep 20:S0883-5403(24)00962-8. doi: 10.1016/j.arth.2024.09.024. Online ahead of print.

Authors

Enrico Festa¹, Tiziana Ascione², Domenico De Mauro³, Donato Di Gennaro¹, Andrea Baldini⁴, Giovanni Balato¹

Affiliations

¹ Orthopedic Unit, Department of Public Health, "Federico II" University, Naples, Italy.
² Service of Infectious Diseases, Cardarelli Hospital, Naples, Italy.
³ Orthopedic Unit, Department of Public Health, "Federico II" University, Naples, Italy; Department of Orthopedics and Geriatric Sciences, Catholic University of Sacred Heart, Rome, Italy.
⁴ Orthopedic Unit, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy.

PMID: 39307205
DOI: 10.1016/j.arth.2024.09.024

Abstract

Background: A 1.5-stage revision could be an alternative to a 2-stage revision for treating hip and knee chronic periprosthetic infections, guaranteeing the maintenance of joint function and infection control and preventing infection-free patients from undergoing further surgery. Our systematic review aimed to answer several questions about the indication, the infection eradication rate, and the long-term functional outcome of 1.5-stage revisions used to treat chronic periprosthetic infections of the hip and knee.

Methods: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies dealing with the use of 1.5-stage and two-stage surgery for chronic periprosthetic joint infection following total knee arthroplasty or total hip arthroplasty The Coleman Methodology Score and the Methodological Index for Nonrandomized Studies score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the infection eradication rate using either the 1.5-stage revision or the 2-stage technique. A total of 494 patients (111 hips and 385 knees) who underwent 1.5-stage with a mean age of 69 years (range, 61 to 82) were identified in the ten included studies.

Results: The most common cause of reoperation was the conversion to the definitive prosthesis, followed by aseptic loosening. Infection control was reached in 84.6% of the 1.5-stage and 76.1% of the two-stage cohorts. The infection recurrence rate was higher in the two-stage cohort than the 1.5-stage group (21.8 versus 14.3%).

Conclusions: The 1.5-stage technique represents a valid treatment option in selected patients who have chronic periprosthetic joint infection who cannot undergo further surgeries, adding together the benefits of the 1- and 2-stage procedures. Furthermore, the 1.5-stage showed a better success rate in the infection resolution than the 2-stage technique.

Keywords: 1.5-stage; THA revision; TKA revision; knee hip PJI; knee hip spacers.