Antibiotic-loaded cement spacers are currently used in two-stage revision of septic total hip arthroplasty as temporary devices. Prolonged spacer implantation in infected shoulder has been described occasionally in poor candidates for reconstruction surgery (medically compromised and/or low-physical demand patients, deficient bone stock). Few papers previously reported the use of spacers in infected hip prosthesis as a permanent solution, but limited information is available on the medium-term behaviour. We detail medium-term clinical and radiographic follow-up of a preformed spacer in the management of a chronically infected hip arthroplasty in a 50-year-old female patient who did not undergo a second-stage surgery. Normalization of inflammatory markers was detected 3 weeks after surgery and persisted over time. Six years after surgery, the patient recovered a good range of motion and was able to walk pain free with assisted weightbearing. Remarkable radiological changes of the bone stock around the spacer stem have been assessed. New bone formation developed rapidly in the femur, leading to the consolidation of transfemoral osteotomy 6 months postoperatively. Two years after implantation, spontaneous and asymptomatic fatigue fracture in the mid-part of the stem occurred. Radiographs at 6 years showed a sufficient preservation of bone stock, though a slowly progressive resorption of the cortical femur around the stem was evident in the last year. In conclusion, prolonged spacer implantation seems to be not appropriate in septic hip arthroplasty as a permanent solution. In patients not undergoing a second-stage surgery, a careful and periodic monitoring is required to rule out possible and severe complications.