Outcomes of Two-Stage Total Hip Replacement for Infected Hemiarthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Arthroplasty Revision

Background:

• Hip hemiarthroplasty infection is a severe complication with limited treatment literature.
• Two-stage revision total hip replacement (THR) is the standard for chronic periprosthetic joint infection (PJI) in THR, but its efficacy in hemiarthroplasty is less studied.

Purpose of the Study:

• To evaluate the clinical, functional, and radiological outcomes of two-stage revision THR for infected hemiarthroplasty.
• To assess the effectiveness of a two-stage THR approach in eradicating infection and restoring function after hemiarthroplasty failure.

Main Methods:

• Retrospective, single-center study of 23 patients with PJI post-hemiarthroplasty undergoing two-stage revision THR (Jan 2015-Jan 2024).
• Infection diagnosis per 2018 Musculoskeletal Infection Society (MSIS) criteria; two-stage procedure involved implant removal, debridement, antibiotic spacer, followed by reimplantation 5-7 weeks later.
• Functional outcomes assessed by Harris Hip Score (HHS); radiological evaluation for implant stability; minimum 2-year follow-up.

Main Results:

• Significant improvement in mean HHS from 26.65 preoperatively to 80.52 postoperatively (p < 0.0001).
• High infection eradication rate of 95.7%, with only one recurrent infection (4.3%).
• Improved mobility: 52% walked without support, 35% used one stick, 13% required constant support; no dislocations or aseptic loosening.

Conclusions:

• Two-stage revision THR demonstrates high infection control and functional recovery in patients with infected hemiarthroplasty.
• This strategy is a reliable and effective treatment option for managing PJI following hip hemiarthroplasty, addressing a gap in current literature.