One-stage exchange should be avoided in periprosthetic joint infection cases with massive femoral bone loss or with history of any failed revision to treat periprosthetic joint infection.

Massive femoral bone loss was associated with greater chances of developing a further septic failure. All septic failures occurred within the first five years following the one-stage exchange. Surgeons should be aware of instability and periprosthetic fracture being potential causes of further aseptic revision surgery. Cite this article: Bone Joint J 2021;103-B(7):1247-1253.