Bilateral short two-stages management of chronic synchronous hip periprosthetic infection: about 3 cases

Purpose: Bilateral synchronous hip periprosthetic infection (HPI) is a rare but severe complication of total hip arthroplasty (THA) with high morbidity and mortality. This study reports our experience with a bilateral, sequential, short two-stage revision protocol to optimize infection control while reducing non-weight-bearing time. Methods: Three patients with bilateral chronic HPI were treated using a four-step approach: (1) unilateral implant removal and antibiotic spacer placement, (2) contralateral implant removal with spacer placement, (3) first reimplantation, and (4) second reimplantation. A 21-day implant-free period was maintained, and bacteriological samples were taken at each stage to guide targeted antibiotic therapy. Success was defined by the absence of further surgery or suppressive antibiotic therapy. Results: Two patients (P1, P3) completed the protocol successfully and regained satisfactory hip mobility at a one-year follow-up. One patient (P2) died after the second implant removal, highlighting the severity of HPI. Bacteriological documentation revealed MSSA in P1 and P2, and MRSE in P3. Hospitalization ranged from 45 to 55 days. Despite the high surgical burden, repeated procedures allowed precise infection control and targeted treatment. Conclusion: A bilateral, sequential, short two-stage approach provides effective infection control and functional recovery while maintaining a 21-day implant-free interval. However, the high number of interventions and prolonged recovery time present significant challenges. Further studies are needed to assess whether this approach reduces the risk of reinfection compared to alternative strategies.