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

• A. Systemic infection with poor soft tissue coverage
• B. Infection with a resistant organism and poor soft tissue
• C. Infection with unknown organism and compromised tissue
• D. Infection with a known organism and good soft tissue

Answer: (D)

One-stage revision works best when the infection is well defined and controllable in a single operation, with the causative organism known and susceptible to antibiotics and the soft tissue envelope healthy enough to heal after reimplantation. In this scenario you can perform thorough debridement, exchange the implants, and place a new prosthesis in the same surgery, backed by targeted antibiotic therapy from the start. The good soft tissue and absence of systemic sepsis give a high chance of eradicating the infection without needing a second operation, while also offering a faster return to function. When the organism is unknown or resistant, or the soft tissue is compromised or there is systemic infection, the risk of persistent infection after a single procedure is much higher, making a two-stage revision the safer approach to first clear the infection and then reconstruct.