Treatment Failure Among Infected Periprosthetic Total Hip Arthroplasty Patients

Ran Schwarzkopf*, 1, Bassem Mikhael 2, Elizabeth Wright 3, Daniel M Estok, II2, Jeffrey N Katz 3
1 Department of Orthopaedics Surgery, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA
2 Orthopaedic Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3 Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

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© Schwarzkopf et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the 101 The City Drive South, Pavilion III, Building 29, Orange, CA 92868, USA; Tel: 714-456-5759; Fax: 714-456-7547; E-mail:


Two-stage revision has been shown to be the most successful treatment in eradicating deep infection following total hiparthroplasty. We identified 62 patients treated by a two-stage revision. We defined “successful revision” as negative intraoperative cultures and no further infection-related procedure. We defined “eradication of infection” on the basis of negative cultures and clinical diagnosis at least one year after 2nd stage procedure. After a mean follow up of 2.7 years, eradication of the infection was documented in 91.1%, and a successful two-stage revision in 85.7% of patients. We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision. We found an association between a history of another previous infected prosthetic joint and a failed 2nd stage procedure. Failure to achieve eradication of infection and successful two-stage revision occurs infrequently. Patients with prior history of a previous prosthetic joint infection are at higher risk of failure.

Keywords: Hip arthroplasty, modular antibiotic cement spacer, periprosthetic infection, two-stage revision surgery. .