Comparison of single-stage versus two-stage revision for the treatment of chronic periprosthetic hip joint infections

Background: While two-stage revision is considered the gold standard, single-stage revision continues to gain popularity for the treatment of chronic periprosthetic joint infections. In this single-provider, single-protocol study, the outcomes between the two approaches were compared. Methods: This was a retrospective study that included 63 consecutive adult patients who underwent single-stage or two-stage total hip revision arthroplasty for chronic periprosthetic joint infection between 2009 and 2020. Only the two-stage approach was performed between 2009 and 2014, while only single stage was performed between 2015 and 2020. Infections were classified using the Delphi-based consensus criteria. Three major outcomes were compared between the revision approaches: the rates of postoperative complications, reinfections, and reoperations. Results: There were 43 (68.3%) single-stage and 20 (31.8%) two-stage revisions. The mean age was 59.5 ± 13 years with 35 (55.6%) women. The mean body mass index was 35.8 ± 9.1 kg/m2. At the mean follow-up rate of 6.9 years (range, 2.1-10.8 years), the rate of no recurrence of infection was 81.4% in the single-stage cohort compared to 80.0% in the two-stage cohort (p = 1.000). Reoperation rate for single-stage revision due to a non-infectious reason was higher than two-stage (20.9% versus 15.0%; p = 0.7367). No statistically significant differences were noted for other postoperative complications. Conclusion: Single-stage revision is as effective as two-stage revision for the treatment of chronic periprosthetic hip joint infections in patients with limited exclusion criteria.