One-, 1.5-, or Two-Stage Revision for Periprosthetic Hip and Knee Joint Infection? A Network Meta-Analysis Comparing Revision Strategies

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• Picked for Orthopedics and Sports Medicine (top studies of the week, 13 September 2026): Network meta‑analysis of PJI revision strategies

Abstract

INTRODUCTION: Periprosthetic joint infection (PJI) remains a devastating complication following total hip and knee arthroplasty. Revision strategies for chronic PJI include one-, 1.5-, and two-stage revision procedures. This study compared clinical outcomes of these revision strategies using a network meta-analytic approach. METHODS: A systematic review and Bayesian network meta-analysis were conducted. Databases were searched through October 2025. Randomized controlled trials and comparative cohort studies evaluating one-, 1.5-, and two-stage revision procedures for hip and knee chronic PJI were included. Chronic PJI was defined by Musculoskeletal Infection Society/International Consensus Meeting (MSIS/ICM) criteria, excluding acute postoperative and hematogenous infections. In the primary network, hip and knee revisions were analyzed together, with pre-specified hip-only and knee-only subgroup networks reported separately. There were 54 studies (10,055 patients) eligible for inclusion. RESULTS: Compared with two-stage revision, both one- and 1.5-stage revisions were associated with significantly lower odds of reinfection (odds ratio (OR) = 0.84, 95% credible interval (CrI) 0.72 to 0.99 and OR = 0.58, 95% CrI 0.37 to 0.89, respectively) and reoperation (OR = 0.79, 95% CrI 0.63 to 0.99 and OR = 0.20, 95% CrI 0.05 to 0.82, respectively). The 1.5-stage strategy demonstrated significantly higher infection control success (OR = 1.64, 95% CrI 1.07 to 2.51). The one-stage revision was associated with fewer overall complications (OR = 0.64, 95% CrI 0.48 to 0.86). The 1.5-stage strategy showed a significantly increased risk of aseptic loosening (OR = 4.80, 95% CrI 1.57 to 20.79), while two-stage revision performed best. CONCLUSION: The 1.5-stage revision was associated with the most favorable infection-related outcomes, but a higher risk of aseptic loosening. The one-stage revision showed intermediate results, while the two-stage revision performed less favorably but had the lowest loosening risk. Because the evidence is largely observational and subject to confounding by indication, these associations should be interpreted cautiously.

Abstract as published, via PubMed.