Background Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) presents a major clinical and economic burden. While 2-stage revision remains the ‘gold standard’ treatment in the United States, 1-stage revision has gained interest due to reduced morbidity and costs. Many small-sample, single-institution studies have compared these revision strategies. However, recurrence and failure rates remain substantial in both approaches, and risk factors for treatment failure are not fully understood, particularly across treatments. Methods This retrospective cohort study used a de-identified database, TriNetX, to identify 4,140 patients with chronic hip PJI after primary THA who underwent either 2-stage (n = 2,293) or 1-stage (n = 1,847) revision between 2006 and 2022. Treatment failure over five years was defined as any need for rerevision, irrigation and debridement, or chronic suppressive antibiotics. Cox proportional hazards modeling was used to identify independent risk factors for failure, reported as age-adjusted hazard ratios (aHR). Results Two-stage revision had a higher 5-year survival without failure (63.3%) compared to 1-stage revision (44.5%, P < 0.001). Significant risk factors for failure in both strategies included body mass index ≥ 30 (2-stage: aHR 1.35; 1-stage: aHR 1.38); prior resistant infection, other than methicillin-resistant Staphylococcus aureus (MRSA) (2-stage: aHR 1.42; 1-stage: aHR 1.49); and anemia (2-stage: aHR 1.19; 1-Stage: aHR 1.28). Additional risk factors for 2-stage revision included prior MRSA infection (aHR 1.39) and liver disease (aHR 1.35), while malnutrition (aHR 1.72) was significant only in 1-stage revision. Conclusion Careful patient selection, particularly when considering 1-stage revision, may help mitigate failure risk and optimize treatment strategies in chronic hip PJI.
John Antoniou (Thu,) studied this question.