Total hip revision arthroplasty: does sepsis influence the results?

The results of revision total hip arthroplasty, with or without sepsis, are compared in a review of the recent literature. In 661 total hip revisions without sepsis, there is an overall 54% excellent/good/satisfactory rate and a 12% infection rate. Of 1063 total hip revisions in the presence of or after sepsis, there is an overall success rate of 73% and a 17% reinfection rate. Comparison of the two groups is difficult due to the different criteria used to diagnose infection, the variable use of parenteral antibiotics and cement impregnated with antibiotics, the frequently short follow-up periods, and the definition of success by different rating s stems. Aside from infection, before advising revision surgery or excision arthroplasty, consideration should be given to the individual patient, the hip to be revised, and the technical skills available. Follow-up should be monitored yearly by an independent examination of the patient, not by chart review or telephone questionnaire. Standardized rating methods should be used, together with strict criteria for the diagnosis of infection. Only in this way will results from different centers be comparable.