Partial prosthetic exchange in the management of chronic prosthetic hip joint infection: a systematic review

The management of chronic prosthetic hip joint infection is complex, typically requiring prolonged antibiotic therapy in combination with complete prosthesis exchange, performed either in a single stage or in two stages. However, the removal of a well-osseointegrated prosthetic component carries significant surgical risks that may adversely affect the outcome of the therapeutic strategy. The partial exchange strategy, understood as the removal of a single prosthetic component while retaining the well-integrated one, has emerged as an alternative approach for the management of selected chronic prosthetic hip joint infections. The primary objective of this study was to review the available evidence on partial prosthetic exchange for the management of chronic hip prosthetic joint infection (PJI).

Studies evaluating partial prosthetic exchange as a treatment for chronic hip prosthetic joint infection up to February 2025 were included. The search terms used were "management prosthetic infection", "partial joint arthroplasty", "retention of well-fixed stem" and "partial exchange". The search was conducted using databases such as PubMed and Ovid. Studies involving other joints, partial prostheses, or cases of acute or hematogenous infection were excluded.

Twenty-one studies with chronic prosthetic hip infection treated with partial exchange were included (319), most published between 2009 and 2025 and all studies were retrospective. The mean age was 63.1 (SD7 years). A two-stage strategy predominated (250 PJIs, 78.4%) compared to one-stage procedures (69 PJIs, 21.6%). Among monomicrobial infections, Gram-positive bacteria were the predominant pathogens (202 cases, 74.7%), with coagulase-negative staphylococci and Staphylococcus aureus being the most frequently isolated microorganisms. The mean time between surgeries was 18.2 weeks (SD 11.9), with substantial heterogeneity in antibiotic regimens. The mean follow-up was 4.9 years (SD 2.0). The overall success rate was 89.3% in the intention-to-treat analysis (285 cases), similar to the per-protocol analysis (89.2%, 281 cases). Two-stage partial exchange showed a higher success rate (90.4%; 226 PJIs) than one-stage procedures (85.5%; 59 PJIs). A total of 34 failures were reported, frequently associated with Staphylococcus spp. (14 PJIs; 41.2% of the failures). Functional outcomes, when reported, showed improvement after the procedure, although this information was not systematically provided across all studies.

Partial exchange may be a viable strategy for managing chronic prosthetic hip joint infection in a selected group of patients, specifically those with a well-fixed prosthetic component. Removing this component is associated with intraoperative and postoperative complications that may compromise joint stability and function. However, the heterogeneity of the studies limits the establishment of clear patient selection criteria. Further studies with higher-quality and larger populations are needed.

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