Revisions for periprosthetic hip infections do not fail more than revisions for aseptic loosening, but mortality is higher

Abstract Background The influence of the reasons for revision on the outcomes of revision hip arthroplasties is controversial and poorly described. A registry study was designed to compare the revision hips performed for periprosthetic hip infection (PHI) to the revision hips performed for aseptic loosening. The aims of this study were the long-term assessment and comparison of survival rates, reasons for re-revisions, mortality rates between these two cohorts. Methods Using an arthroplasty registry, revision hips were stratified according to the reasons for revision (aseptic loosening and PHIs). Pre-operative and intra-operative demographics and implant-related features were recorded. Survival rates, reasons for revision and mortality rates were assessed and compared. Results The two cohorts were homogenous for pre-operative and intra-operative parameters, apart from age at revision, time elapsed between THA and revision, bearing surfaces and head size. At 10 years, the survival rates were similar between the two groups (p = 0.51). Half of the re-revisions occurred in the first two years in both the groups. The reasons for re-revision were similar: when re-revision for infection was adopted as end-point, the two cohorts showed non-significant differences. The mortality rate was statistically higher in the PHI cohort (p 0.0015, hazard ratio adjusted for age and gender: 1.42). Conclusion Aseptic and septic revisions achieved similar outcomes at long-terms, re-revisions tended to fail for the same reason for revision. Mortality rate was significantly higher in the septic cohort. These findings are useful to modify and tune the pre-operative, intra-operative and post-operative managements of revisions.