Long Term Results of Two-Stage Revision for Chronic Periprosthetic Hip Infection: A Multicenter Study

Two-stage exchange arthroplasty remains the gold standard in the United States for treatment of chronic periprosthetic joint infection (PJI). Long-term reinfection rates and clinical outcomes with sufficient subject numbers remain limited. The purpose was to evaluate the long-term outcomes following two-stage exchange following hip arthroplasty.

Retrospective review of 221 patients who underwent two-stage exchange hip arthroplasty for chronic PJI at three large tertiary referral institutions from 1990-2015. Outcomes including reinfection, mortality, and all-cause revision were calculated. Cumulative incidence of reinfection with death as competing factor was also calculated. Risk factors for reinfection were determined using Cox multivariate regression analysis.

Rate of infection eradication and all-cause revision was 88.24% and 22.6%, respectively. Overall mortality rate was 40.72%. Patients with minimum five-year follow-up (n = 129) had a success rate of 91.47% with mortality rate of 41.1%. Major risk factors for reinfection included polymicrobial infection (HR = 2.36, 95% CI: 1.08-5.14) and antibiotic resistant organism (HR = 2.36, 95% CI: 1.10-5.04).

This is the largest series with greater than 5-year follow-up evaluating outcomes of two-stage exchange hip arthroplasty. This technique resulted in a relatively high infection eradication, however, the mortality rate is alarmingly high. Antibiotic resistant organisms appear to be highest risk factor for failure.