Functional outcomes of infected hip arthroplasty: a comparison of different surgical treatment options



Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) can be treated with irrigation and debridement with head and polyethylene exchange (IDHPE) or 2-stage revision (2SR). Few studies have compared patient-reported outcome measures (PROMs) in patients managed with these treatments.


A retrospective review identified 137 patients who had an infected primary THA between 1986-2013. Control cohorts were matched according to age and Charlton Comorbidity Index (CCI). Harris Hip Scores (HHS), Short Form 12 (SF12), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared between the control and infected cohorts.


68 patients underwent a 2SR and 69 patients underwent an IDHPE. IDHPE had a 59% success rate in eradicating infection. PROMs for the 2SR cohort were significantly worse than the noninfected controls (SF12-PCS [34.0 vs. 38.3, p = 0.03]; HHS [76.6 vs. 91.7, p<0.001]; and WOMAC [67.3 vs. 79.3, p = 0.005]). There were no significant differences between the noninfected cohort and the successful IDHPE. Significant differences were found between failed IDHPE and noninfected controls (SF12-PCS [42.5 vs. 34.0, p = 0.011]; HHS [92.3 vs. 79.6, p = 0.004]). There was only difference in SF12-MCS scores (50.3 vs. 57.3, p = 0.012) between the 2SR and failed IDHPE cohorts.


Patients treated with a successful IDHPE had similar outcomes to noninfected patients. Patients that failed IDHPE and went onto 2SR had similar outcomes to those that had a 2SR alone. IDHPE demonstrated a 59% success rate with PROMs equivalent to a noninfected cohort and should be considered in the treatment algorithm of infected THA.

Hip Int 2017; 27(3): 245 - 250




Benjamin V. Herman, Mark Nyland, Lyndsay Somerville, Steven J. MacDonald, Brent A. Lanting, James L. Howard

Article History


Financial support: There is institutional research support from DePuy, Smith & Nephew, Zimmer, Microport and Stryker.
Conflict of interest: BVH, MN and LS none.
SJM is a paid consultant and receives royalties from DePuy. He holds stock or stock options in JointVue and Hip Innovations Technology.
BAL is a paid consultant for IntelliJoint and Stryker.
JLH is a paid consultant for Stryker and DePuy.

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  • Division of Orthopaedic Surgery, Department of Surgery, Western University, London Health Sciences Centre, London - Canada

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