• PURPOSE
    • Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following total hip arthroplasty (THA). The objectives of the study were to: 1) determine the minimum 2-year infection-free survivorship of two-stage revision THA; 2) determine the causative organisms for repeat two-stage revision THA; and 3) characterize the results of failed two-stage revisions and evaluate patient-reported outcome measures (PROMs).
  • METHODS
    • A retrospective chart review was completed for patients who underwent two-stage revision THA for PJI. Prospective data was collected on each patient, including demographics, causative organisms, complications, and type of reoperation. The PROMs, including Harris Hip Score (HHS), 12-item Short-Form Health Survey (SF-12), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were obtained prior to two-stage revision THA surgery and annually as part of standard clinical and radiographic follow-up.
  • RESULTS
    • A total of 328 patients who underwent a two-stage revision THA for a PJI were included in the study (mean age 67 years (range, 28 to 90), mean BMI of 30.6 (range, 15 to 57). The overall infection-free survivorship for two-stage revision THA was 73.8% at a minimum of 2 years (range, 2 to 20). Overall, 194 (59.1%) patients who had successful infection eradication underwent a two-revision THA only. The most common single organisms infected were Staphylococcus aureus (12.5%) and Staphylococcus epidermidis (11%). Higher reoperation rates were found in cases with MRSA and polymicrobial infections. All PROMs showed statistical improvement from pre-operatively to the latest follow-up appointment.
  • CONCLUSIONS
    • Two-stage revision THA is associated with a good success rate in the treatment of PJIs at mid- to long-term follow-up. Polymicrobial and MRSA infections are poor prognostic factors, making the eradication of infection more difficult. The management of periprosthetic joint infections continues to be one of the most important orthopaedic challenges to treat.