Revision arthroplasty for periprosthetic joint infections: When to consider one-stage versus two-stage protocols?

For chronic periprosthetic joint infection, two-stage exchange arthroplasty has long remained the gold-standard treatment, but has come under scrutiny of late. Recent studies have shown increased costs, unacceptably high rates of recurrence for resistant organisms, and lower than expected rates of eventual reimplantation for subjects treated in a two-stage fashion. While the appeal of single-stage exchange arthroplasty has grown, rigorous data is lacking for universal application for all infections. Improvements in patient selection with set criteria for appropriate use will better define a treatment algorithm for optimum periprosthetic joint infection management moving forward.