Partial versus full revision in cementless single-stage exchange for hip periprosthetic joint infection: a multicenter comparative study with 10-year survivorship analysis

Abstract

Background Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty (THA). Traditional management typically involves full revision to ensure comprehensive infection eradication. However, for patients with well-fixed implants, partial revision in a single-stage cementless approach may provide a viable alternative, potentially preserving bone stock and reducing operative time. The relative efficacy of this approach compared with full revision remains to be fully explored. This multicenter study aims to determine whether partial revision in cementless single-stage exchange surgery offers comparable infection control outcomes to full revision for select patients with well-fixed implants. Methods We conducted a retrospective, multicenter cohort study involving 226 patients who underwent cementless single-stage exchange hip arthroplasty for PJI between 1 October 2013 and 31 July 2022. Patients were divided into partial revision (n = 61) and full revision (n = 165) groups. The primary outcome was treatment success, defined as the absence of clinical symptoms and signs of infection at a minimum follow-up of 2 years. Results The success rates were 77.0% for the partial revision group and 80.0% for the full revision group, with no significant difference (p = 0.629). Both groups showed comparable 10-year survival rates for overall success and infection-free status. Patients with partial revision had significantly shorter operative times (137.3 versus 169.1 min, p < 0.001). Age >= 65 years (odds ratios (OR): 2.433, p = 0.003), American Society of Anesthesiologists (ASA) score >= 3 (OR: 1.778, p = 0.030), and chronic kidney disease (OR: 3.467, p = 0.053) were identified as independent risk factors for reinfection in the partial revision group. Conclusions Partial cementless single-stage revision may offer comparable infection control to full revision in selected hip PJI cases with well-fixed implants, while reducing operative time. Given the retrospective design, these findings should be interpreted with caution, and future prospective studies are needed to confirm long-term outcomes, assess implant survival, and evaluate functional recovery.