Salvage re-revision total hip arthroplasty for severe femoral and acetabular bone defect complicated by periprosthetic joint infection and stem loosening: insights from geriatric orthopedics

Revision total hip arthroplasty with massive femoral and acetabular bone loss plus chronic periprosthetic joint infection is formidable in geriatric patients. A 73-year-old woman managed with a staged, soft-tissue-first pathway: extensive debridement, targeted antibiotics, and dead-space/coverage optimization, followed by defect-specific re-reconstruction. The acetabulum was rebuilt with a porous cup–cage anchored in reliable host bone; cavitary defects were buttressed with antibiotic-loaded cement. The femur was reconstructed using a modular tapered, fluted stem achieving diaphyseal fixation, with distal interlocking to enhance torsional control in a short, compromised isthmus. At 10 months, the patient had marked pain relief, community ambulation with a cane, and no reinfection, dislocation, or stem subsidence; radiographs demonstrated a stable cup–cage and maintained hip center. Although the techniques are established, this report highlights a pragmatic sequence integrating infection control, soft-tissue readiness, and fixation choices in a frail host, offering practical decision points for similarly complex re-revisions.