Chronic periprosthetic joint infection (PJI) remains one of the most devastating complications following total hip (THA) and total knee arthroplasty (TKA), often leading to severe functional decline, high morbidity, and significant healthcare costs. For decades, the two-stage exchange has been the undisputed “gold standard” in North America, boasting infection eradication rates between 81% and 100%. This approach involves removing the infected implants, placing a temporary antibiotic-loaded cement spacer, administering a prolonged course of antibiotics, and finally, performing a second surgery to implant definitive prostheses once the infection is deemed clear.
However, the two-stage process is arduous, subjecting patients to multiple major surgeries, prolonged periods of reduced mobility, and the inherent risks of living with a temporary spacer. While the one-stage exchange (removing infected implants and placing new ones in a single operation) is popular in Europe and currently the subject of a major U.S. randomized trial, it requires meticulous patient selection and may not be suitable for all cases, particularly those involving resistant organisms or severe soft-tissue defects.
