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May 18, 2026Open Access

Outcomes of Two-Stage Total Hip Replacement for Infected Hemiarthroplasty

Key Points

This study aims to evaluate the clinical, functional, and radiological outcomes of two-stage revision THR in patients with infected hemiarthroplasty.
Retrospective level IV study including 23 patients with chronic PJI following hemiarthroplasty.
Two-stage revision THR with implant removal, antibiotic spacer placement, and targeted therapy.
Follow-up of at least two years with functional assessment using the Harris hip score.
Mean Harris hip score improved significantly from 26.65 preoperatively to 80.52 postoperatively (p < 0.0001).
Infection control was achieved in 95.7% of patients, with one case of recurrent infection (4.3%).
52% of patients were walking without support at the last follow-up, and no significant complications such as dislocations or implant migration were noted.

Abstract

Infection following hemiarthroplasty of the hip is a devastating complication associated with significant morbidity. While two-stage revision total hip replacement (THR) is the gold standard for chronic periprosthetic joint infection (PJI) in total hip arthroplasty, literature focusing on infected hemiarthroplasty remains limited. This study evaluates the clinical, functional, and radiological outcomes of two-stage revision THR in patients with infected hemiarthroplasty. This retrospective level IV study, conducted in a single center, included 23 patients with confirmed PJI following hemiarthroplasty who underwent two-stage revision THR between January 2015 and January 2024 with a minimum follow-up of two years. Infection was diagnosed using the updated 2018 Musculoskeletal Infection Society (MSIS) criteria. The first stage involved implant removal, debridement, and placement of an antibiotic-loaded cement spacer, followed by targeted antibiotic therapy. Reimplantation was performed after five to seven weeks. Functional outcomes were assessed using the Harris hip score (HHS), and radiological evaluation assessed implant stability. Statistical analysis was performed using a paired t-test. The cohort included 14 females and 9 males, with a mean age of 65.96 years. The mean HHS improved significantly from 26.65 preoperatively to 80.52 postoperatively (p < 0.0001). Infection was eradicated in 95.7% of patients, with one case (4.3%) of recurrent infection. Additionally, 52% of the patients were walking without support, 35% of the patients were using one stick for taking long walks, and 13% of patients always required stick support in the last follow-up. No dislocations, aseptic loosening, or implant migration were observed. There was one intraoperative periprosthetic fracture, which was successfully managed. Two-stage revision THR was associated with high infection-control rates and functional improvement in this series of infected hemiarthroplasty patients and remains a reliable treatment strategy.

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