Humphries H, Wignadasan W, Fontalis A, Alsheddi A, Shaeir M, Haddad F S
Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK.
NHS Foundation Trust, London, UK.
Indian J Orthop. 2025 May 21;59(7):901-909. doi: 10.1007/s43465-025-01405-6. eCollection 2025 Jul.
Total hip arthroplasty (THA) is a highly successful procedure for managing hip osteoarthritis, with increasing numbers performed yearly. Prosthetic joint infection (PJI) is a devastating complication which remains one of the leading causes of implant failure and is increasing in prevalence, resulting in significant morbidity, mortality, and economic burden. Traditional management of PJI has relied on two-stage revision, but recent evidence suggests that single-stage revision may be an effective alternative for select patients. This review looks at the pathogenesis, diagnosis and classification of PJI in THA, and examines the current literature on single-stage revision for PJI in THA, including its indications, surgical technique, and clinical outcomes. Indication of the procedure is determined by the patient comorbidities and biology, and micro-organism characteristics. The surgical technique involves the removal of infected implants, thorough debridement, and reimplantation of a new prosthesis within the same procedure. Single-stage revision is associated with reduced hospital stays, lower costs, and improved patient satisfaction compared to two-stage revision. While successful eradication of infection depends on factors such as host immunity, pathogen virulence, and soft tissue viability, studies have demonstrated comparable or superior infection-free survival rates for single-stage revision. Recent advances in microbiological diagnostics, biofilm disruption techniques, and multidisciplinary perioperative management have further enhanced the efficacy of single-stage revision. Despite some contraindications, including highly resistant organisms and severe soft tissue compromise, high-volume centers have expanded their indications with promising results. As the demand for THA continues to rise, optimizing PJI treatment strategies is critical. This review highlights the growing role of single-stage revision as a viable and cost effective approach for managing PJI in carefully selected patients.
全髋关节置换术（THA）是治疗髋关节骨关节炎的一种非常成功的手术，每年实施的例数不断增加。人工关节感染（PJI）是一种极具破坏性的并发症，仍然是植入物失败的主要原因之一，并且发病率在上升，导致显著的发病、死亡和经济负担。PJI的传统治疗依赖于两阶段翻修，但最近的证据表明，单阶段翻修可能是部分患者的有效替代方案。本综述探讨了THA中PJI的发病机制、诊断和分类，并研究了目前关于THA中PJI单阶段翻修的文献，包括其适应症、手术技术和临床结果。该手术的适应症由患者的合并症、生物学因素和微生物特征决定。手术技术包括在同一手术过程中取出感染的植入物、彻底清创并重新植入新的假体。与两阶段翻修相比，单阶段翻修可缩短住院时间、降低成本并提高患者满意度。虽然成功根除感染取决于宿主免疫力、病原体毒力和软组织活力等因素，但研究表明单阶段翻修的无感染生存率相当或更高。微生物诊断、生物膜破坏技术和多学科围手术期管理的最新进展进一步提高了单阶段翻修的疗效。尽管存在一些禁忌症，包括高度耐药的微生物和严重的软组织损伤，但大型中心已扩大了其适应症范围并取得了令人鼓舞的结果。随着对THA的需求持续上升，优化PJI治疗策略至关重要。本综述强调了单阶段翻修作为一种可行且具有成本效益的方法，在精心挑选的患者中管理PJI的作用日益增强。
