A Comparison of 1.5-Stage and Two-Stage Revisions for Prosthetic Joint Infection in Total Hip and Knee Arthroplasty - Meta-Analysis of Outcomes

Sep 28, 2026

Uploaded by Ben

Prosthetic joint infection (PJI) is a severe complication after total hip and knee arthroplasty. Two-stage revision is traditionally considered the standard, while 1.5-stage revision has become an alternative amid ongoing uncertainty about the optimal surgical approach. This meta-analysis systematically compared comparative outcomes between 1.5-stage and two-stage revisions, assessing reinfection, infection eradication failure, aseptic loosening, complications, readmission, and periprosthetic fracture.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Abstract

Introduction And Background

Burden and outcomes of PJI

Historical role of two-stage revision

Emergence of 1.5-stage revision

Theoretical advantages and ongoing controversy

Review began 10/13/2025 Review ended 11/24/2025 Published 11/30/2025 © Copyright 2025 Ibrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98180 Open Access Review Article A Comparison of 1.5-Stage and Two-Stage Revisions for Prosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Meta-Analysis of Outcomes Abdelrahman Ibrahim 1, Khadija Khamdan 2, Salman Sadiq 3, Ahmed Lyeeq 1, Nikhil Narayanswamy 2, Abu Saeed 4 1. Trauma and Orthopaedics, Princess Royal Hospital NHS Trust, Telford, GBR 2. Trauma and Orthopaedics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR 3. Trauma and Orthopaedics, Russells Hall Hospital, Dudley, GBR 4. Trauma and Orthopaedics, Worcestershire Acute Hospitals Trust, Worcester, GBR Corresponding author: Abdelrahman Ibrahim, [abdelrhmangharib3@gmail.com](abdelrhmangharib3@gmail.com) Abstract Prosthetic joint infection (PJI) is a devastating complication of total hip and knee arthroplasty. Whilst twostage revision has long been considered the gold standard treatment, the 1.5-stage revision has emerged as a viable alternative. However, the optimal surgical strategy remains a subject of debate. The aim of this metaanalysis was to evaluate the comparative outcomes of 1 .5-stage versus two-stage revision for PJI. A systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting comparative outcomes of 1 .5-stage versus two-stage revision were included, and their risk of bias was assessed. Reinfection, failure of infection eradication, aseptic loosening, overall complications, readmission, and periprosthetic fracture were the evaluated outcome parameters. All comparative studies reporting on patients who underwent either a 1.5-stage or a two-stage revision were included in the final analysis. The 1.5-stage revision was associated with a significantly lower rate of reinfection (odds ratio (OR) : 0.62; 95% confidence interval (CI) 0.40-0.96, p = 0 .03) but a significantly higher rate of aseptic loosening (OR: 6.12; 95% CI 1 .09-34.22, p = 0 .04) when compared with the two-stage revision. No significant difference was found in the rates of infection eradication (OR: 1.35; 95% CI 0.80-2.27, p = 0.26), overall complications, readmission, dislocations, or periprosthetic fracture between the two groups. A subgroup analysis for knee PJI was consistent with the main analysis for reinfection. The meta-analysis of the best available evidence indicates that a 1.5-stage revision for PJI is associated with a lower rate of reinfection but a higher risk of aseptic loosening. High-quality randomized controlled trials are needed to definitively establish the optimal surgical strategy for managing PJI. Categories: Trauma, Orthopedics Keywords: 1.5-stage revision, meta-analysis, prosthetic joint infection (pji), tka (total knee arthoplasty), total hip arthroplasty (tha), two-stage revision arthroplasty Introduction And Background Periprosthetic joint infection (PJI) is a catastrophic complication following total joint arthroplasty (TJA), with an incidence of 1% to 2%[1-3]. Mortality after a PJI has been reported to be as high as 11% in total hip arthroplasty (THA) and 14 .4% in total knee arthroplasty (TKA), which is comparable to common cancers [3,4] . As the volume of primary and revision TJA procedures is projected to grow substantially, PJI is becoming the leading cause for early revisions [5], placing a great burden on the healthcare system with annual costs expected to reach $1 .85 billion by 2030 in the United States [6,7] . Two-stage revision arthroplasty has historically been considered the gold standard for treating chronic PJI [8,9] . Absolute indications for staged

FAQs

What was the purpose of the meta-analysis?

To evaluate and compare the outcomes of 1.5-stage versus two-stage revision for prosthetic joint infection (PJI).

Which outcomes differed significantly between 1.5-stage and two-stage revisions?

1.5-stage revision showed a significantly lower reinfection rate, but a significantly higher rate of aseptic loosening compared with two-stage revision.

Were overall complication and infection eradication rates different between the two approaches?

No significant differences were found in infection eradication rates and overall complications, readmission, dislocations, or periprosthetic fracture between the groups.

Sep 28, 2026

Uploaded by Ben