Partial 2Stage Revision in Chronic Hip Arthroplasty Infections: A Review

Background: Periprosthetic hip infections (PHIs) are troublesome complications of hip arthroplasties. The gold standard procedure for treating chronic PHI is a 2stage approach. Recently, however, more conservative approaches have been developed to spare the osseointegrated components and avoid sequestra, bone loss, devascularization, and difficult reconstructions. The partial twostage approach, which leaves the wellfixed component in situ and removes the loosened component, may be an effective strategy. Objective: This paper, a narrative minireview, analyzed the preliminary results of a partial 2stage approach to treating chronic hip arthroplasty infections. Methods: Pertinent papers describing the partial 2stage approach (leaving the wellfixed component in situ and removing the loosened component) were collected and evaluated. Results: Six main case series were selected. A total of 76 patients were included. Many patients were treated with socket removal and stem retention with quite similar surgical techniques. Many cases included highly virulent bacteria, and no preoperative selection about comorbidities was performed. The first outcomes of this approach were promising, with a rate of infection control ranging from 81.3% to 100% at midterm followup. Conclusion: This approach proved good at midterm followup; however, many concerns still exist. In particular, the indications are imprecise, and the role of biofilm is still unclear. Despite the first good outcomes, the partial 2stage approach for chronic PHI should be validated by multicenter prospective studies.