One-stage revision arthroplasty for infected total hip replacement: principles and outcomes

Background: Periprosthetic joint infection (PJI) of the hip is a significant complication traditionally managed via two-stage revision. While one-stage revision has gained traction due to reduced healthcare costs and the avoidance of multiple surgeries, its implementation requires strict surgical rigor and multidisciplinary coordination to ensure outcomes comparable to two-stage protocols.

Objective: This article aims to define the prerequisites, pathophysiological rationale, and technical principles of one-stage revision arthroplasty for chronic hip PJI, while evaluating its clinical indications and success rates.

Key Points: Successful management relies on a multidisciplinary team involving infectious disease specialists, microbiologists, and orthopedic surgeons. Pre-operative joint aspiration is essential, demonstrating 88% concordance with intra-operative cultures. The surgical procedure necessitates radical debridement of all infected soft tissue and complete removal of implants and cement, often requiring extended femoral osteotomies. Reconstruction utilizes modular revision implants, dual-mobility components, or structural allografts to address bone loss. Post-operative antibiotic therapy is typically administered for six to twelve weeks. Clinical data from a prospective cohort of 157 chronic PJI cases treated with one-stage revision showed a 95% infection-free survival rate at five years, even in cases involving resistant organisms or sinus tracts.

Conclusion: One-stage revision arthroplasty is an effective strategy for the majority of hip PJI cases. By achieving high infection eradication rates and superior functional outcomes compared to two-stage procedures, it serves as a primary treatment option when managed within specialized referral centers.