1.5-Stage TKA at Hackensack University Medical Center Offers Mobility Advantages

Second-stage knee replacement surgery can be planned electively or avoided entirely in many cases

Performing revision surgery for infection following primary total knee arthroplasty (TKA) used to require a compromise: Giving up mobility for six weeks, during a two-stage revision, or performing a single replacement procedure, but risking complex revisions later if the infection persists.

A newer 1.5-stage revision approach blends the infection management and success rate advantages of the two-stage procedure with the mobility and patient convenience advantages of the single-stage approach.

In recent years, physicians in pockets around the U.S., including Stephen Rossman, D.O., now an orthopedic surgeon at Hackensack University Medical Center, began concurrently exploring 1.5-stage approaches in place of two-stage TKA, which was the gold standard in the U.S. at the time.

In the two-stage TKA, a temporary knee spacer made out of brittle antibiotic cement is inserted with prolonged IV antibiotic treatment. Full weight bearing during this time is discouraged, as the spacers have a risk of fracture or dislocation. In the 1.5-stage TKA, an articulating spacer is placed with a metal femur and plastic tibial component with the intent to retain the implant for as long as the patient can tolerate it. If the implant does become loose over time or the infection returns, the second stage procedure can more easily and electively be performed.

Though, some patients never need an additional surgery due to the joint’s durability and functionality—the initial joint can potentially perform successfully for the duration of a recipient’s life. If and when it does need to be replaced, it can often be scheduled electively for the patient’s convenience.

“Patients can function almost as if they had a primary knee replacement,” Dr. Rossman said.

A majority of patients who have experienced an infection after initial TKA are candidates for the 1.5-stage procedure, Dr. Rossman said. The 1.5-stage procedure can be used when contraindications preclude the single-stage approach, and with success rates comparable to the two-stage procedure.

Dr. Rossman served as a moderator for the total joint section at the American Osteopathic Academy of Orthopedics 2023 annual meeting and presented his experiences with 1.5-stage TKA, and educates residents and medical students on the approach.

Learn more about innovative orthopedic care at Hackensack University Medical Center.