A comparative analysis of 1.5-stage stem hybrid fixation versus two-stage exchange arthroplasty for periprosthetic hip infection : is a 1.5-stage exchange equivalent?

Abstract

Two-stage exchange arthroplasty is frequently used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards single-surgery options such as 1.5-stage exchange. Therefore, we sought to compare 1.5- and two-stage patients and determine: 1) baseline demographic details, comorbidities, infection, surgical, and inpatient characteristics; 2) re-revision rates and causes, hip pain and implant loosening of surviving implants, success/failure according to the Musculoskeletal Infection Society (MSIS) outcome reporting tool, and mortality at latest follow-up; and 3) whether the type of surgery (1.5- vs two-stage) is a re-revision predictor. We undertook a retrospective review of 73 patients who underwent either 1.5-stage stem hybrid fixation (n = 43) or two-stage exchange hip arthroplasty (n = 30) at a single institution (March 2019 to May 2023). Demographic information and variables of interest were compared between groups. Predictors of re-revision were assessed with logistic regression. The mean follow-up was 454 days (23 to 1,620). Our cohorts were not significantly different, except for a higher proportion of 1.5-stage patients classified as American Society of Anesthesiologists (ASA) grade III or IV (77% vs 50%; p = 0.025). There were more prior revisions among 1.5-stage patients (mean 1.5 vs 0.7; p = 0.012), whereas mean length of follow-up and mean operating time were significantly longer among two-stage patients (650 vs 317 days, p = 0.002; and 501.3 (360 to 660) vs 267.2 mins (150 to 420), p < 0.001, respectively). In the 1.5-stage group, there was a significantly higher proportion of periprosthetic infections as a cause of re-revision (80% vs 0%; p = 0.011). Postoperative success or failure (MSIS outcome) and mortality rates were not statistically significantly different. The type of surgery was not a significant re-revision predictor. Our preliminary data suggest that our selective prescription of 1.5-stage revision was associated with significantly more re-revisions due to infection when compared with two-stage patients. We acknowledge the potential benefits of the 1.5-stage strategy, especially among high-risk patients, as it involves a single operation; however, higher reinfection rates must be considered when counselling these patients.