Two Stage Hip Revision in Periprosthetic Infection: Results of 41 Cases

Giovanni Pignatti1, Shingo Nitta2, Nicola Rani*, 1, Dante Dallari1, Giacomo Sabbioni1, Cesare Stagni1, Armando Giunti1
1 7th Ward of Orthopedic-Trauma Surgery, Rizzoli Orthopedic Institute, Bologna, Italy
2 Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan

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© Pignatti et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 7th Ward of Orthopedic-Trauma Surgery, Rizzoli Orthopedic Institute, via Pupilli 1, 40136 Bologna, Italy; Tel: +390516366437; Fax: +390516366840; E-mail:



two-stage revision is considered the best treatment approach for the eradication of chronic joint infection. We report the outcome of 41 consecutive patients with infected hip prostheses, treated between 2000 and 2005, with two-stage revision using an antibiotic-loaded cement spacer.


Patients underwent a treatment protocol which included clinical and radiographic evaluation, laboratory investigations, hip aspiration, 99mTc-MDP and 99mTc-leukocyte-labeled scintigraphy and intraoperative assessment. All patients were diagnosed with a late chronic infection and classified as B-host according to the Cierny-Mader classification system. 9 patients out of 41 (22%) required a second interim treatment period, with exchange of the spacer. The proportion of methicillin-resistant Staphylococcus was similar between the one-spacer group and two-spacer group (28% vs 33%), whereas the proportion of patients with three or more risk factors was significantly higher in the two-spacer group than in the one-spacer group (28% vs 55%, respectively).


Forty patients had final reimplantation, one patient had a resection arthroplasty. At an average follow-up of 5.3 years no recurrence of infection occurred. The average post-operative Harris hip score improved from 41 to 80.


In the treatment of two-stage revision arthroplasty the adherence to the protocol proved to be effective for infection eradication and final reimplantation.

Keywords: Infection, hip, revision, spacer.