Infected knee replacement: one-stage or two-stage revision?

The short verdict

Two-stage revision has long been the standard approach for established infection in a knee replacement, because it allows a period of targeted antibiotics with no permanent implant in place. One-stage revision is increasingly used in carefully selected patients where the organism is known and treatable and the soft tissues are healthy. The choice depends on the infection, your health and the condition of the bone and skin, and is made with an infection specialist.

How they compare

• Number of operations: one-stage is a single major operation; two-stage means two, with a spacer in between
• Between stages: with two-stage, you usually have weeks of antibiotics and limited walking with the spacer before the new knee
• Suitability: one-stage tends to need a known organism sensitive to antibiotics, healthy skin and good bone; two-stage suits more complex or unclear infections
• Recovery: one-stage avoids a second recovery and time with a spacer; two-stage takes longer overall
• Infection control: both can work well in the right patient; results depend heavily on selection and teamwork
• Early infection: very early infections, within weeks of surgery, may sometimes be treated by washing out the joint and changing the plastic insert while keeping the implant

Who each option tends to suit

One-stage revision tends to suit people whose infection has been identified before surgery with a standard, treatable organism, whose skin and soft tissues are in good condition, and who are otherwise reasonably well. Two-stage revision tends to suit people with an unknown or resistant organism, a draining wound or poor skin, significant bone loss, previous failed treatment, or medical conditions that weaken the immune system.

When to seek help in Doha

Contact a surgeon promptly if your knee replacement becomes increasingly painful, hot, swollen or red, if a wound leaks, or if you develop fever. Do not start antibiotics before the joint has been assessed, if possible, because they can hide the organism. Dr. Gelber at Aman Hospital will arrange blood tests, joint fluid testing and imaging, and plan treatment with microbiology colleagues.