Cementless one-stage hip revision arthroplasty with an injectable antibiotic bone graft substitute : a pilot study

The classic, widely accepted approach for one-stage hip revision arthroplasty in patients with periprosthetic joint infection (PJI) is the cemented exchange. This approach provides stable implant anchoring despite bone defects after removal of infected components, and facilitates local antibiotic delivery. This study aims to investigate the efficacy of cementless one-stage hip revision arthroplasty using a gentamicin-eluting bone graft substitute (GBGS) to address both bone defect filling and antibiotic elution.

We conducted a prospective analysis of 20 patients with confirmed PJI undergoing cementless one-stage hip revision arthroplasty using GBGS. The GBGS was used to fill femoral and acetabular defects during implantation. Clinical outcomes, radiographs, adverse events, and patient-reported outcome measures (PROMs) including Harris Hip Score (HHS) and EuroQol five-dimension five-level questionnaire (EQ-5D-5L) were assessed. Patients received 12 weeks of systemic antibiotics and were followed up for at least 24 months.

The mean age of the cohort was 66.3 years (SD 8.4; 46 to 80), with ten female and ten male patients. On average, 13.2 ml (SD 3.9; 5 to 17) of GBGS was applied to bone defects. No reinfections occurred during the follow-up period of 3.3 years (SD 0.92; 2.1 to 4.8). We observed 15 serious adverse events (SAEs), none of which were associated with the product. All cases showed good bony consolidation and prosthesis integration at 12 months. Significant improvements were seen in HHS (preoperative mean: 47.7; final visit mean: 80.1; p < 0.001) and EQ-5D-5L score (preoperative mean: 0.43; 12-month mean: 0.88; p < 0.001).

This prospective pilot study is the first to demonstrate the safety and feasibility of single-stage cementless hip exchange arthroplasty using GBGS in managing PJI and associated bone defects. The technique resulted in significant improvements in functional outcomes and quality of life, with a good safety profile. Further studies with larger cohorts are warranted to validate these findings.