Two-stage Revision Total Hip Arthroplasty without Spacer Placement: A Viable Option to Manage Infection in Patients with Severe Bone Loss or Abductor Deficiency

Abstract Background High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a non-spacer two-stage revision. This study reports on the clinical course of a contemporary two-stage exchange for periprosthetic hip infection without spacer insertion. Methods We reviewed 141 infected THA with extensive bone loss or abductor damage who underwent two-stage exchange without spacer placement. The mean duration from resection arthroplasty to reimplantation was 9 weeks (2-29). Clinical outcomes included interim revision, reinfection and aseptic revision rates. Restoration of leg-length and offset was assessed radiographically. Modified Harris hip scores (mHHS) were calculated. Mean follow-up was 5 years (3-7). Treatment success was defined using the modified Delphi consensus criteria. Results 34 patients (24%) had treatment failure, including 13 reinfections, 16 interim re-debridements for persistent infection, 2 antibiotic suppressive therapies and 3 PJI-related deaths. Aseptic re-revision after reimplantation was necessary in 14 patients (10%). Dislocation accounted for most aseptic complications, with 20 dislocations occurring in 15 patients (11%). Leg-length and offset were restored to preoperative measures. Mean mHHS significantly improved from 35 points to 67 points. Conclusion A non-spacer two-stage exchange is a viable option for managing chronically infected THA with severe bone loss or abductor deficiency, showing comparable rates of interim revision and recurrence of infection. Cementless reimplantation demonstrates good mid-term survivorship with comparable functional outcomes and leg-length restoration. However, dislocation continues to be a major concern.