Variations in clinical practice of one-stage septic revisions in chronic hip and knee periprosthetic joint infections: an international questionnaire study

Abstract

Introduction

Recent studies have increasingly provided evidence that one-stage septic revisions for hip and knee are a safe treatment option for periprosthetic joint infections (PJI) in selected patients. However, there is still a wide treatment variation concerning indications and execution among different practices. This study aimed to describe these differences.

Methods

We set out an online questionnaire among members of the European Bone and Joint Infection Society (EBJIS) in September 2023. The questionnaire consisted of questions investigating indications, execution, and preferences regarding one-stage hip and knee septic revisions. Descriptive analysis was performed of all results and Chi-squared tests were used to test for differences in opinions between subgroups of respondents.

Results

Sixty-five orthopaedic revision arthroplasty surgeons completed the questionnaire. 68% prefer to standardly perform two-stage revisions and only do one-stage revisions in selected patients. However, there was no consensus on which (contra-)indications should be used to select these patients. The most important reason to not perform one-stage revisions was fear of a higher reinfection risk, partly due to inconclusive literature. There was also no consensus on which perioperative antimicrobial measures should be applied.

Conclusions

Notable differences in indications for and execution of one-stage septic revisions persist. We encourage others to share their experiences with this procedure. Moreover, clinical trials should be undertaken to provide stronger evidence for the safety of one-stage septic revisions and to provide clear and uniform guidelines.