One- vs. Two-Stage Exchange for Chronic Hip Periprosthetic Joint Infection: A Framework Based on Patient Treatment Burden and Institutional Capability.

Abstract

» Recent evidence demonstrates equivalent infection-eradication rates between one-stage revision (OSR) and two-stage revision (TSR) in chronic hip periprosthetic infection at experienced centers. » The decision between OSR and TSR should account for patient treatment burden, which includes functional limitation, spacer complications, medical morbidity, psychological burden, and cost. » Traditional OSR selection criteria may identify patients with greater overall surgical complexity rather than reliably unfavorably biasing reinfection risk. » Standardized institutional protocols are critical for the success of OSR and include careful patient selection, microbiologic planning, thorough debridement, clean-phase separation and dual setup, experience with complex hip revision surgery, and multidisciplinary coordination. » TSR remains appropriate in clinical scenarios involving fungal infection, substantial host compromise, prior failed septic revision, and at institutions where highly specific and standardized protocols cannot be reliably implemented.