Comparison of the efficacy of one-stage revision surgery guided by precise pathogen diagnosis and conventional two-stage revision for chronic knee periprosthetic joint infection.

Aims: This study aimed to assess whether the clinical outcomes of one-stage revision surgery for chronic knee periprosthetic joint infection (kPJI), guided by precision pathogen diagnosis strategies, are non-inferior to those of conventional two-stage revision surgery.

Methods: A retrospective analysis was conducted on chronic kPJI patients who underwent precision pathogen detection and revision arthroplasty at the First Affiliated Hospital of Fujian Medical University between January 2016 and September 2022. Clinical characteristics, pathogen detection rates, targeted antibiotic therapy, reinfection rates, and functional outcomes were compared between patients who underwent one-stage and two-stage revision surgeries.

Results: Thirty patients who underwent one-stage revision surgery with pathogen detection through precision pathogen diagnosis strategies were included in this study and were matched with 30 patients who received two-stage revision surgery via propensity score matching (PSM). The baseline clinical characteristics did not significantly differ between the two groups. Utilizing our optimized pathogen detection protocol, successful pathogen identification was achieved in all cases across both groups. The median duration of intravenous antibiotic administration in the one-stage revision cohort was 16.5 (8.5,23.0) days, followed by a 6-week course of sequential oral antibiotics. Both the one-stage and two-stage revision groups had 3 cases of reinfection each, with no statistically significant difference in success rates between the groups (P > 0.999). Furthermore, no significant differences were found in the range of motion (ROM) (P = 0.332) or Knee Society score (KSS) (P = 0.117) between the one-stage and two-stage revision groups at the 2-year postoperative follow-up. The Kaplan‒Meier survival curves for prosthesis infection-free survival nearly overlapped, with no statistically significant differences between the two groups (P = 0.675).

Conclusion: When pathogen identification is achieved through precision diagnostic strategies, the efficacy of one-stage revision surgery combined with targeted antibiotic therapy is comparable to that of two-stage revision surgery.