The Infected TKA: One-stage or Two-stage Exchange?

    Overall, more than 17% of failures in primary total knee arthroplasty (TKA) are revised because of infection. [1] In early revision, the percentage of failure attribute to infection is even higher at 38%. [2]

    The devastating nature of a periprosthic joint infection in TKA dictates a quick diagnosis and effective treatment aimed at eradicating the infecting organism.

    Two-stage exchange is generally considered to be the preferred treatment for a periprosthetic joint infection following TKA. [1] A 2012 study by Romano et al showed that two-stage exchange is more likely to eradicate the infection than a one-stage exchange. [2]

    At the Philadelphia Revision Course, we asked Gwo-Chin Lee, MD, from the University of Pennsylvania in Philadelphia, to discuss the role of one-stage versus two-stage exchange in his practice. Click the image above to hear his comments.

    Producer: Susan Doan-Johnson; Director: Michael Bugera; Post-Production: Charles Maynard


    1. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 2002 Nov;(404):7-13.
    2. Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001 Nov;(392):315-8.
    3. Lichstein P, Gehrke T, Lombard A, et al. One-stage versus two-stage exchange. J Orthop Res. 2014 Jan;32 Suppl 1:S141-6. doi: 10.1002/jor.22558.
    4. Romano CL, Gala L, Logoluso N, et al. 2012. Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc 20:2445–2453.