Clinical value of causative pathogen identification in one-stage revision for periprosthetic joint infection

Introduction: Total hip arthroplasty is one of the most successful modern surgical procedures, yet periprosthetic joint infection (PJI) remains a serious complication associated with disability and increased postoperative mortality. Aim: This study highlights the importance of identifying the causative microorganism and its antibiotic susceptibility profile for the successful application of a one-stage revision protocol in treating PJI. Materials and methods: Between October 2017 and July 2023, 33 patients underwent one-stage revision total hip arthroplasty. Preoperative joint aspiration and intraoperative periprosthetic tissue sampling were performed in all cases, with microbiological analysis conducted. The study group consisted of 15 men and 18 women, with a mean postoperative follow-up of 33 months (range 2–66 months). Results: A pathogen was identified in 31 patients. Staphylococcus epidermidis was the most common microorganism, responsible for 44.1% of infections. Staphylococcus aureus was found in 14.7% of cases. Enterococcus faecalis was isolated in three patients, and Serratia marcescens in two. No infection recurrence was recorded during follow-up. Complications included two postoperative dislocations, both managed with closed reduction, and one death due to pulmonary embolism. Functional outcomes improved, with the mean Harris Hip Score increasing from 54.3 preoperatively to 72.3 postoperatively. Conclusion: In this selected cohort, one-stage revision was associated with favorable short- to mid-term outcomes. These findings suggest that, when guided by precise microbiological diagnosis and multidisciplinary management, one-stage revision may be a viable option for carefully selected patients with periprosthetic hip infection.