One-stage vs. two-stage revision for periprosthetic joint infection after total elbow arthroplasty: A systematic review and meta-analysis

Abstract

Background

Revisions for periprosthetic joint infection following total elbow arthroplasty (TEA) can be performed using one- or two-stage protocols. Evidence remains inconclusive regarding which approach results in lower reinfection rates. This study aimed to compare reinfection outcomes. Secondary outcomes were planned but not analysed due to limited data.

Methods

PubMed, MEDLINE, Embase, and the Cochrane Library were searched for studies reporting reinfection following one- or two-stage TEA revision. Two reviewers independently extracted data, with discrepancies resolved by a third reviewer. Pooled reinfection rates were calculated using random effects models.

Results

Four studies (16 patients) reported one-stage revision, with a pooled reinfection rate of 18.8% (95% CI: 3.75–57.7%) and no heterogeneity (I² = 0%). Fifteen studies (235 patients) reported two-stage revision, with a pooled reinfection rate of 22.0% (95% CI: 13.0–34.3%) and low heterogeneity (I² = 10%). Sensitivity analysis excluding one outlier increased the rate to 24.3% (95% CI: 14.7–37.4%).

Conclusion

Evidence comparing one- and two-stage revision for infected TEA is limited. Pooled reinfection rates were numerically similar, but data are insufficient to determine comparative effectiveness. Prospective studies are required.