Treatment results of chronic periprosthetic hip infection depending on relative contraindications for single-stage revision arthroplasty

Background. Traditionally, single-stage revision arthroplasty was recommended only for a very limited cohort of patients. However, in the last decade, a global trend towards expanding the indications for this surgical option can be observed. The need to reduce the hospital costs for the treatment of periprosthetic joint infection (PJI) often leads to the shortening of preoperative period by refusing to wait for the results of microbiological investigation (MBI). The aim of the study — to evaluate the effectiveness of single-stage revision arthroplasty in patients with chronic periprosthetic hip infection, depending on the presence or absence of relative contraindications to this procedure. Methods. The study included 40 patients with chronic hip PJI who underwent surgical treatment between January 2022 and May 2024. After obtaining biomaterials (aspiration and/or tissue biopsies), preliminary MBI results were awaited within 5 days. After that, the patients were allocated into two groups. Group 1 included patients in whom a single strain of Gram-positive bacteria was isolated, Group 2 — patients in whom no pathogen growth was detected, or in whom polymicrobial associations or Gram-negative bacterial strains were identified. In Group 1, surgery was performed only after the final MBI results were available, whereas in Group 2, the final results were not awaited. All patients underwent single-stage revision arthroplasty, and local antibacterial therapy was performed within 3 days after surgery. The follow-up period for the cohort was no less than 24 months. Results. Periprosthetic joint infection was successfully managed in 97.5% of cases (n = 39). The following relative contraindications to single-stage revision arthroplasty were identified: data on the pathogen and its antibiotic susceptibility were unavailable at the time of surgery in 67.5% of patients, 37.5% had a functioning fistulous tract, 27.5% had recurrent PJI, and 5% — massive acetabular defects (Paprosky type 3B) along with multiple prior debridement procedures. No impaired kidney function, adverse local or systemic reactions were observed during local antibacterial therapy. Conclusions. With effective local antibacterial therapy, the indications for single-stage revision arthroplasty can be expanded, and the procedure can be successfully performed — even in the absence of data on the causative pathogen at the time of surgery. However, the following conditions remain essential for performing a single-stage procedure: absence of severe comorbidities, as well as extensive soft-tissue and/or bone defects, and the feasibility of administering local therapy in the early postoperative period along with prolonged systemic oral antibiotic therapy.