Infection as a cause of primary total hip arthroplasty revision and its predictive factors

Infection is a serious complication of total hip arthroplasty (THA) and is one of the most frequent causes of failure. The goal of this study was to evaluate the importance of infection among the different causes of revision THA and identify any risk factors specifically associated with this cause of revision.

All patients who underwent a first revision of THA were included in a prospective multicenter study. Postoperative clinical and radiological evaluation and follow-up of morbidity and mortality were performed at 3 months.

Two hundred forty out of 2107 revisions (11.4%) were performed for infected THA, which was the third cause after aseptic loosening (42.3%) and peri-prosthetic fractures (11.8%). These patients had a higher BMI associated with co-morbidities and lower clinical scores than patients with other causes of revision. One-stage revision was performed in most cases (66%) with replacement of the complete implant in 86% of cases, resulting in longer surgery compared to that for other causes. Male gender (OR 2.3), avascular necrosis (OR 2.4), arthroplasties with dual mobility cups (OR 2.5) and a Rottinger anterolateral approach (OR 3.4) were all associated with an increased risk of infection.

Some of these risk factors are not or have rarely been reported in the literature. They should be taken into consideration to help in the prevention and continuing battle against THA infection.

Level IV, prospective cohort study.