One-stage versus two-stage prosthesis replacement for prosthetic knee infections

Med Mal Infect. 2019 Oct;49(7):519-526. doi: 10.1016/j.medmal.2019.01.013. Epub 2019 Feb 19.


Introduction: Periprosthetic knee infection is a severe complication. Confirmed criteria are lacking to choose between one-stage or two-stage prosthesis replacement to treat the infection. The one-stage replacement could lead to a satisfactory control of the infection and to better functional results.

Method: Retrospective study conducted between January 1, 2009 and December 31, 2014. The objectives of this study were to compare the infection outcome and functional results between the one-stage and two-stage replacement procedures. Functional results were evaluated using the IKS score, KOOS score, and SF-12 quality of life score.

Results: Forty-one patients underwent a two-stage replacement procedure and 21 patients a one-stage replacement. The average follow-up was 22 months after surgery. The infection was cured in 78% of patients who underwent a two-stage replacement and 90% of patients who underwent a one-stage replacement (P=0.3). The flexion range of motion was significantly better in the one-stage group than in the two-stage group (P=0.04). Results of the IKS score and of the KOOS score were better in the one-stage group. No difference was observed for the SF-12 score.

Conclusion: The one-stage replacement procedure for periprosthetic knee infection was associated with a similar healing frequency as the two-stage replacement procedure, and with better knee function.

Keywords: Infection de prothèse de genou; Prosthesis replacement; Prosthetic knee infection; Prothèse totale de genou; Remplacement de prothèse; Total knee prosthesis.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / methods*
  • Female
  • Humans
  • Knee Prosthesis / adverse effects*
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / etiology*
  • Prosthesis-Related Infections / surgery*
  • Reoperation
  • Retrospective Studies