HIP; Surgical Technique: Bone Loss and Muscle Insufficiency

Periprosthetic joint infection (PJI) is a devastating complication following joint arthroplasty, leading to significant morbidity and healthcare costs. The current gold standard for treatment is the two-stage exchange arthroplasty, which involves the removal of the infected prosthesis, a period of antibiotic therapy, and subsequent re-implantation of a new prosthesis. However, this approach imposes a considerable burden on patients, including multiple surgeries, prolonged hospital stays, and functional limitations. There is growing evidence suggesting that one-stage exchange arthroplasty may be an equally effective alternative. One-stage exchange involves the removal of the infected prosthesis and foreign material, radical debridement of the affected tissues, and immediate re-implantation of a new prosthesis in a single surgical procedure utilizing targeted antimicrobial therapy. Advantages of one-stage exchange arthroplasty include reduced patient burden, shorter hospital stays, and earlier return to function. Additionally, this approach is based on the accurate identification of the causative organism enabling targeted antibiotic therapy both systemically and locally. When this is combined with proper surgical technique and appropriate choice of implants, the success rates of one-stage exchange procedures are comparable to the two-stage approach. Although the literature on one-stage exchange arthroplasty is limited compared to the extensive evidence supporting two-stage exchange, current studies have shown promising outcomes and lower overall morbidity. Nevertheless, large multi-centered randomized controlled trials are needed to compare postoperative outcomes, including infection control rates and functional scores, and to establish definitive guidelines for the management of this complex condition.