JOA - 2026-05-01 - Journal Article; Comparative Study
One- Versus Two-Component Single-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infections: Medical Complications, Hospital Readmissions, and Failures.
Plancher KD, Kalala SC, Fleissig JC, Briggs KK, Petterson SC
Topics
Key Takeaway
One-component single-stage revision TKA for PJI carries 5.3× higher odds of 90-day infection-related readmission versus two-component exchange, while two-component exchange has 3.7× higher odds of aseptic loosening-driven failure at five years.
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Summary
This study compared infection-related readmissions and five-year failure rates between one- and two-component single-stage revision TKA for PJI using a large national database with propensity score matching on age, sex, ECI, obesity, and tobacco use. One-component exchange produced OR 5.3 for infection-related readmission at 90 days and OR 4.9 at six months versus two-component exchange. Two-component exchange had higher overall five-year failure (OR 1.2), driven entirely by aseptic loosening (OR 3.7), not recurrent infection.
Key Limitation
The database cannot distinguish Tsukayama classification type (acute postoperative, late chronic, or acute hematogenous), which is the primary determinant of single-stage candidacy and directly confounds the infection recurrence comparison between groups.
Original Abstract
BACKGROUND
Single-stage revision total knee arthroplasty (TKA) can be an effective alternative to two-stage revision for periprosthetic joint infection (PJI) following TKA. The purpose of this study was to compare medical complications, hospital readmissions, and failure between one- and two-component single-stage revision TKA for PJI.
METHODS
A large national database was queried for patients who underwent single-stage revision TKA for PJI. The one- and two-component exchanges were propensity score matched by age, sex, Elixhauser Comorbidity Index (ECI), obesity, and tobacco use. There were 3,974 one-component and 3,974 two-component exchanges.
RESULTS
The one-component exchanges had significantly increased odds of readmission at 90 days with the diagnosis of infection (odds ratio [OR]: 5.3, confidence interval [CI]: 4.3 to 6.5) and six months (OR 4.9 [CI: 4.0 to 5.9]; P < 0.01). Significant predictors of infection at six months were age, ECI, anemia (OR 1.3 [CI: 1.1 to 1.4]; P < 0.001), acute kidney injury (OR 1.3 [CI: 1.1 to 1.4]; P < 0.001), and alcohol disorders (OR 1.2 [CI: 1.02 to 1.5]; P = 0.03). Failure at five years was significantly higher in the two-component exchange (OR: 1.2 [CI: 1.04 to 1.3]; P = 0.007). A two-component exchange had significantly increased odds (OR: 3.7 [CI: 2.5 to 5.4]; P < 0.001) of aseptic loosening, not infections, as the cause of failure. Significant predictors of failure at five years included age, ECI, anemia, and acute kidney injury.
CONCLUSIONS
Patients who were treated with single-stage revision TKA for PJI with a one-component exchange were five times more likely to require readmission with the diagnosis of infection. Failure rates at five years were noted to be higher in two-component exchanges due to aseptic loosening. Patient selection for revision TKA for PJI should include evaluation of all comorbidities/ECI to avoid medical readmissions with infection.
LEVEL OF EVIDENCE
Therapeutic Level III.