At our institution, periprosthetic hip joint infections are treated according to a previously defined treatment algorithm. Each patient is evaluated regarding risk factors such as duration of clinical signs and symptoms, stability of the implant, condition of the soft tissue, and antimicrobial susceptibility of the microorganism. Depending on these factors, either debridement with retention, one-stage exchange, or two-stage exchange with spacer (short interval, 2–4 weeks), or without spacer (long interval, 8 weeks) is performed. Very rarely, resection arthroplasty or lifetime suppression is necessary. All surgical procedures are combined with an antimicrobial therapy for 6 or 12 weeks, depending on the surgical pathway. For infection due to staphylococci, whenever possible, rifampicin is used in combination with a fluoroquinolone. From 2002–2006, 89 patients with 95 episodes (3 patients with 2 independent episodes, 3 patients with bilateral infection) of periprosthetic hip joint infection have been treated at our hospital. Five patients died within 2 years after revision, one of them with septic shock related to the periprosthetic hip joint infection. One patient is living abroad. All other patients (n=83) had consecutive follow-up visits at least until 2 years after infection treatment without recurrence. Debridement with retention has been performed in 18 episodes, one-stage exchange in 25 episodes, two-stage exchange with temporary spacer for 2–4 weeks has been performed in 26 episodes, and two-stage exchange without spacer and an interval of 8 weeks in 19 episodes. In 4 cases, immediate resection arthroplasty was performed and 3 patients received long-term suppression therapy. After debridement with retention, 3 recurrences and one event of death occurred (4/18=22.2%), 3 of them did not fulfil the criteria of the algorithm. No failure was observed after one-stage exchange (0/25). Treatment with two-stage exchange was followed by one failure in the group with spacer and short interval (1/26=3.8%), as well as one in the group without spacer and long interval (1/19=5.3%). No recurrence occurred after resection arthroplasty or suppression therapy. All 5 patients with relapse could be cured with a one- or two-stage exchange and remained without recurrence. Comparing one-stage versus two-stage exchange, one-stage exchange is known to have better functional results. It is associated with better patient acceptance, shorter hospital stay, and therefore lower economic burden.

In conclusion, one-stage exchange implies no increasing risk of recurrence provided that the standards of our algorithm are considered.

Introduction: In treatment for prosthetic hip joint infection (PHJI), the advantages of a 1-stage exchange over the classic 2-stage approach are the lower morbidity and earlier rehabilitation. Secondly, a recently published treatment algorithm for PHJI using well-defined selection criteria for 1-stage exchange had a 85–100% rate of cure for infection. Patient satisfaction after hip surgery is highly influenced by the functional result. We hypothesized that in our used algorithm the functional and radiological outcomes after a 1-stage exchange due to an implant-associated infection would be similar to a matched control group of 1-stage exchange due to aseptic loosening.

Material and Methods: Twenty-two cases (21 patients), with PHJI according to a well-defined definition, after 1-stage exchange of the prosthesis strictly according to the algorithm, with index-surgery between april 1996 and october 2004, were included in the studygroup. Case-matching was performed with aseptic revised cases for previous surgery, type of implant, use of transfemoral osteotomy, Charnley score, duration of follow-up, age, and sex. Outcome measures were perioperatively complications, functional results (Harris hip score, limping, and use of walking support) at two years, and the occurrence of revision for any reason and radiological loosening at latest follow-up. All outcomes were compared between both groups and with the results of the two stage revisions in our cohort. Finally, the eradication of infection was scored.

Results: In 86% of the 1-stage group (n = 19) there was an event-free follow-up for ≥ 2 years. The mean Harris hip score was 84, the incidence of limping 20% and 10% required two crutches. Two stems were revised due to aseptic loosening. Both functional and radiological outcomes were not different from the matched control group.

In the 2-stage group (n = 50) results were lower but not significantly, with 80, 30% and 28% respectively, and 2 stems and 1 cup were revised due to aseptic loosening.

One case (after one stage) developed an infection with a different pathogen and one case (after two stage exchange) had a relaps of infection.

Conclusion: By using the identical surgical technique in both septic and aseptic revision hip surgery, functional results are comparable between groups. These results indicate that 1-stage exchange according to a strict algorithm leads to a successful outcome in both maintaining functional mobility and eradicating infection.