Clinical Outcomes of Partial Two-Stage Revision with Femoral Stem Retention in Elderly Patients with Hip...

Background/Objectives: Periprosthetic joint infection (PJI) of the hip remains a challenging complication, particularly in elderly patients who may not tolerate repeated invasive procedures. While two-stage, one-stage, and 1.5-stage revisions are established strategies, an optimal approach for elderly patients with a well-fixed femoral stem remains unclear. This study evaluated the clinical outcomes of partial two-stage revision with femoral stem retention in elderly patients with hip PJI. Methods: A retrospective review was conducted of patients aged 65 years or older who underwent two-stage revision for hip PJI without femoral stem extraction at a single institution and had a minimum follow-up of one year after the final treatment. Patients were treated with aggressive debridement, removal of all components except the femoral stem, and placement of an antibiotic-loaded cement spacer and beads. Clinical outcomes, infection eradication, complications, and functional status were assessed. Results: Twenty-eight patients (28 hips) were included, with a mean age of 79.5 years and a mean follow-up of 46.2 months. The index arthroplasty was hemiarthroplasty in most cases (92.9%). Seventeen patients completed a second-stage revision, while 11 remained with cement spacer retention. Infection control was achieved in all patients (100%) at final follow-up, with initial infection control achieved in 96.4%. No recurrence of infection was observed in either group. Multidrug-resistant organisms were identified in 67.9% of cases. Functional outcomes were acceptable, and no stem-related complications or reinfections occurred. Conclusions: Partial two-stage revision with femoral stem retention provided effective infection control and acceptable functional outcomes in elderly patients with hip PJI. This approach may be considered a reasonable treatment option for elderly patients with a well-fixed femoral stem when reducing surgical invasiveness is an important consideration.