Infection management in hip arthroplasty: Comparative insights on revision strategies

Periprosthetic joint infection (PJI) remains a major complication following total hip arthroplasty (THA), often necessitating revision surgery. Debate persists regarding the optimal approach between single-stage and two-stage revision strategies.

This retrospective comparative study evaluated 60 patients (30 in each group) undergoing revision THA for chronic PJI. Patients were matched demographically, and outcomes were assessed over 24 months. Primary endpoints included infection recurrence and functional scores, including the Visual Analog Scale (VAS) for pain.

At 24-month follow-up, neither group demonstrated reinfection (0 % recurrence in both cohorts). VAS scores were slightly better in the single-stage group at 3, 6, and 12 months postoperatively (mean 1.9 vs 2.2 at 6 months, p = 0.24). The two-stage group had longer hospital stays and greater overall healthcare costs. Polymicrobial infections were more common in the two-stage cohort (20 % vs. 10 %), while 15 % of all cases were culture-negative. Staphylococcus aureus was identified as the primary pathogen in 46.7 % and 50.0 % of the respective groups. At 24 months, the Harris Hip Score averaged 85.4 ± 6.2 for single-stage compared to 83.3 ± 7.1 for two-stage revisions.

Both revision strategies are viable for managing chronic PJI, with comparable reinfection rates. However, single-stage revision may offer faster pain relief and reduced resource utilization. Clinical decision-making should consider factors such as infection type, organism profile, patient comorbidities, and surgical expertise.