To investigate the clinical effect of peri-prosthetic infection treatment of two-stage exchange without the use of the spacers.

Twenty-one patients with hip peri-prosthetic infection following hip replacement, who underwent the spacer-free two-stage revision in the Second Affiliated Hospital of Xi'an Jiao Tong University from August 2009 to December 2017, were analyzed. These patients included six males and 15 females, aged from 28 to 76 years. In the first stage, these patients were treated by surgical removal of all components without spacers. When the clinical evaluation and serum inflammatory markers suggested the infection had been resolved, the second stage of debridement and new prosthesis replacement was performed. The effects were evaluated with Harris hip score and limb shortening via paired t-test and Wilcoxon rank sum test.

All the patients were followed up for (4.0±2.8)years on average. The hip Harris score(86.4±4.4) at the last follow-up was significantly higher than the score(48.4±4.9) before two-stage revision(t=25.509, P<0.01). The preoperative length of the affected limb was 4.3(3.85, 4.90) cm shorter than that of the healthy side, while it was 0.1cm(-0.2, 0.35) cm (negative value represented the increased length of the affected side compared with the healthy side) after the two-stage revision, and the difference was significant(Z=-4.016, P<0.01). One patient was infected after the operation.

Two-stagerevision without spacer has a high infection control rate in the treatment of periprosthetic hip infection, and does not result in significant shortening of the limb due to peripheral tissue contracture of the hip; the patients could get better hip function.