{
  "abstract": "Periprosthetic joint infection (PJI) remains a devastating complication of total hip arthroplasty (THA), and chronic PJI in the presence of a well-fixed femoral stem is particularly challenging because removal of an osseointegrated stem carries substantial morbidity. Partial two-stage exchange (P2-SE) with femoral stem retention, in which the acetabular components are removed and replaced with an antibiotic-cement functional spacer while the well-fixed stem is retained and debrided, has emerged as an alternative to complete one-stage or two-stage exchange. The direct anterior approach (DAA), although widely adopted for primary THA, has rarely been described for the management of PJI. This article reports three cases of chronic PJI managed by P2-SE performed entirely through the original anterior interval, together with a comprehensive review of the published outcomes of P2-SE. Two of the three patients achieved infection control and were pain-free and ambulatory at final follow-up with an antibiotic-loaded cemented acetabular construct (a polyethylene liner with a modular ceramic head in one, a dual-mobility construct in the other), and did not require second-stage reimplantation, while the third patient developed a recurrent infection after cessation of oral suppression and was subsequently converted to a formal two-stage exchange. The accompanying literature review demonstrates infection eradication rates of approximately 81 to 100% across predominantly Level IV series, with reported outcomes comparable to those of complete two-stage exchange. P2-SE through the DAA appears to be a reasonable option in carefully selected patients with a well-fixed femoral stem, although further prospective comparative investigation is warranted.",
  "abstract_shown": true,
  "affiliations": [
    "Yale School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, USA",
    "Hannover Medical School, Department of Orthopaedics, Hannover, Germany",
    "Torkieh J: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "George A. Rublev"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Nils Becker"
    },
    {
      "affs": [
        2
      ],
      "name": "Joseph Torkieh"
    },
    {
      "affs": [
        0
      ],
      "name": "Thomas R. Hickernell"
    },
    {
      "affs": [
        0
      ],
      "name": "Lee E. Rubin"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3vav3x12azny4.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jcot.2026.103646",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13738144/",
  "id": "3vav3x12azny4",
  "issns": [
    "0976-5662",
    "2213-3445"
  ],
  "landing_url": "https://doi.org/10.1016/j.jcot.2026.103646",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review Article"
    ],
    [
      "openalex",
      "2746|Orthopedic Infections and Treatments"
    ]
  ],
  "openalex": "W7223273394",
  "pdf_url": "https://www.journal-cot.com/article/S0976-5662(26)00315-2/pdf",
  "pmcid": "PMC13738144",
  "pmid": "42991666",
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/3vav3x12azny4.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:23:11Z",
      "native_id": "PMC13738144",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jcot.2026.103646"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Orthopedic Infections and Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Managing periprosthetic joint infection through the direct anterior approach: Partial two-stage exchange with femoral stem retention",
  "title_text": "Managing periprosthetic joint infection through the direct anterior approach: Partial two-stage exchange with femoral stem retention",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:23:11Z",
  "url": "https://research.draconitic.com/paper/3vav3x12azny4",
  "venue": "Journal of Clinical Orthopaedics and Trauma",
  "versions": []
}