Outcome of infected total hip arthroplasty. An inclusive, consecutive series

Twenty-one infected total hip arthroplasties in 19 patients performed between 1971 and 1982 were prospectively followed, using a computerized standard orthopaedic arthritis record. These cases represent an inclusive and unselected, consecutive series. The mean follow-up period from time of infection was 4.8 years (range, 1.2-11.7 years). Infection was diagnosed by positive bacteriologic culture. Ten hips grew a staphylococcal species, 5 a single gram-negative organism, 1 a Streptococcus, and 5 multiple organisms. At final follow-up evaluation, only three hips (14%) had the previously infected prosthesis still in situ, and these had no evidence of ongoing deep infection. Five additional hips (24%) were successfully salvaged after one- or two-stage prosthetic exchange. Two hips (10%) have an infected prosthesis in situ. Eleven hips (52%) had resection arthroplasty, three after attempts at prosthetic reinsertion. Therefore, at final follow-up evaluation, only 8 of the 21 hips (38%) have an apparently infection-free salvaged or reinserted prosthesis in place. Good prognostic factors for prosthetic salvage/successful reinsertion include Staphylococcus epidermidis infection and a traumatic etiology necessitating later hip arthroplasty. Poor prognostic factors include infection with Staphylococcus aureus or multiple organisms and a preoperative diagnosis of avascular necrosis.