# Diagnosis and surgical treatment of chronic destructive septic hip arthritis

## TL;DR

This paper reviews the diagnosis and surgical treatment of a rare and severe hip infection, highlighting current methods and future research needs.

## Contribution

The paper provides a comprehensive overview of diagnostic and surgical approaches for chronic destructive septic hip arthritis and suggests future research directions.

## Key findings

- Chronic destructive SHA diagnosis requires a combination of clinical indicators and metagenomic sequencing.
- One-stage spacer implantation plus two-stage arthroplasty is currently the standard surgical treatment.
- One-stage arthroplasty is a newer treatment with advantages but limited surgical applicability.

## Abstract

Septic hip arthritis (SHA) is a relatively rare but hazardous disease. Much controversy exists regarding the definition, diagnosis and treatment of chronic destructive SHAs. This review aims to provide an overview of the diagnostic and therapeutic approaches for chronic, destructive SHA and suggest possible research directions for this disease’s future diagnosis and treatment. There is no unified naming or classification standard for SHAs. Chronic destructive SHA still requires a comprehensive diagnosis combining history, signs, bacterial culture, histopathological examination, inflammation and other indicators, of which metagenomic next-generation sequencing is a promising diagnostic tool. Previous treatment options for this disease include debridement, debridement + Girdlestone femoral head and neck resection, and debridement + Girdlestone femoral head and neck resection + two-stage arthroplasty. Among them, one-stage spacer implantation + two-stage arthroplasty is the current standard surgical option with a high success rate and low reinfection rate, while one-stage arthroplasty is a new treatment option proposed in recent years with unique advantages but limitations in terms of surgical indications. In the future, more high-quality studies are needed to provide the latest evidence to support clinical decision-making.