The ‘2-in-1’ stage: indications, technique & results

Prosthetic joint infections remain an ongoing challenge for orthopaedic surgeons with an interest in knee arthroplasty, which relates to their often difficult diagnoses, need for multiple surgeries, increased technical and financial requirements. Peri-prosthetic joint infection is devastating complication for the patient and with the current literature unable to either demonstrate superiority of one or two stage revision then we should continue to assess on a case by case basis. The use of a ‘2 in 1’ single-stage approach has been recently been promoted as a form of single stage revision for infection on account of the potential for reduction in risks, costs, and complications. Where it is safe to do so, a single stage procedure can avoid several of the drawbacks which may occur with a formal two stage approach. Particularly, it can reduce the risk of post-operative stiffness and arthrofibrosis which can be associated with two stage surgery. Use of a single stage may be more cost effective, by saving the patient having to undergo a second major procedure. This article reviews the indications for its use, technique and results. The use of ‘2-in-1’ single-stage revision can be considered as an effective option for treating infection following TKR and cases with associated bone loss.