Selective Component Retainment in the Treatment of Chronic Periprosthetic Infection After Total Hip Arthroplasty: A Systematic Review
Authors: Rosinsky PJ, Greenberg A, Amster-Kahn H, Campenfeldt P, Domb BG, Kosashvili Y
Background
- Chronic periprosthetic joint infection (PJI) following total hip arthroplasty (THA) is a challenging complication. Traditional management often includes complete component removal, but some cases may allow for retaining well-fixed components.
Methods
- This systematic review included nine studies assessing outcomes of selective component revision strategies (partial revisions with retained femoral or acetabular components) for chronic hip PJIs.
Key Findings
- Overall infection eradication rate: 89.4%
- Femoral-only revisions had higher success rates compared to acetabular-only or both-component revisions.
- Study heterogeneity and overall evidence quality were limited.
Conclusions
- Selective component retainment during revision for chronic PJI can be successful, particularly when well-fixed implants are involved, but patient selection is critical.
What Does This Mean for Providers?
- Selective revision should be considered in patients with well-fixed, non-loosened components, particularly when femoral fixation is sound.
- While evidence supports a high success rate, case selection, surgical technique, and microbiologic considerations remain paramount.
- Given variability in study quality, providers should apply this strategy cautiously and in conjunction with infectious disease consultation and multidisciplinary planning.