In an infected arthroplasty, one-stage revision is most appropriate under which scenario?

• A. Two-stage revision is preferred for localized infection with known organism
• B. One-stage revision is suitable for all infections
• C. One-stage revision is used for resistant organisms or poor soft tissue
• D. Infection with a known organism and good soft tissue

Answer: (D)

When the infecting organism is known and the soft tissue envelope is good, a one-stage revision is appropriate because you can perform definitive debridement and remove the infected components, then reimplant a new prosthesis in the same operation with antibiotics targeted to that specific organism. Knowing the pathogen allows you to choose the most effective antibiotic regimen and to ensure the new implant is protected by appropriate antimicrobial coverage from the outset. Good soft tissue condition means there is adequate vascular supply and wound coverage, reducing the risk of wound healing problems and fistula formation after a single operation.

In contrast, scenarios where the organism is unknown, or the pathogen is resistant, or the soft tissues are compromised, carry higher risks of persistence or reinfection if tackled in one stage. Those situations are better served by a two-stage approach, which provides time to confirm the organism, tailor therapy, and stage a reimplantation after ensuring the infection is controlled.