Abstract
»Recent evidence demonstrates equivalent infection-eradication rates between one-stage revision (OSR) and two-stage revision (TSR) in chronic hip periprosthetic infection at experienced centers.»The decision between OSR and TSR should account for patient treatment burden, which includes functional limitation, spacer complications, medical morbidity, psychological burden, and cost.»Traditional OSR selection criteria may identify patients with greater overall surgical complexity rather than reliably unfavorably biasing reinfection risk.»Standardized institutional protocols are critical for the success of OSR and include careful patient selection, microbiologic planning, thorough debridement, clean-phase separation and dual setup, experience with complex hip revision surgery, and multidisciplinary coordination.»TSR remains appropriate in clinical scenarios involving fungal infection, substantial host compromise, prior failed septic revision, and at institutions where highly specific and standardized protocols cannot be reliably implemented.