Joint Arthroplasty in sequelae of septic arthritis of the hip: a therapeutic guideline to single or two stage procedures

Background: Acute septic arthritis of the native hip requires urgent intervention to prevent articular destruction, yet the optimal surgical strategy for transitioning to total hip arthroplasty remains variable. While two-stage protocols are standard for active infections, the management of quiescent cases—defined by clinical remission and normalized inflammatory markers—requires distinct therapeutic guidelines to minimize reinfection risks and optimize functional outcomes.

Objective: This study aims to evaluate a differentiated surgical protocol for septic hip arthritis, utilizing a two-stage approach for acute infections and a one-stage arthroplasty for quiescent cases based on a 25-year institutional experience.

Key Points: A retrospective analysis of 22 hips (20 patients) categorized cases into Group 1 (acute, n=9) and Group 2 (quiescent, n=13). Group 1 underwent initial debridement, femoral head resection, and placement of an antibiotic-loaded cement spacer, followed by delayed prosthesis implantation after normalization of erythrocyte sedimentation rate and C-reactive protein. Group 2 received primary total hip arthroplasty at least two years post-infection. Results indicated 100% infection eradication in both groups. Functional recovery, measured by Harris Hip Score, improved significantly in both cohorts, though Group 1 showed a higher mean postoperative score (93) compared to Group 2 (88), likely due to the absence of long-term soft tissue contractures associated with chronic sequelae.

Conclusion: Differentiating between acute and quiescent septic arthritis is essential for surgical planning. A two-stage protocol effectively manages active infection, while a one-stage procedure is safe for quiescent cases with normalized laboratory parameters and a sufficient symptom-free interval.