Infection in Revision Total Hip Arthroplasty

Summary Though one of the most common and dangerous complications in the early years of total hip replacement, the incidence of infection has dramatically decreased. In revision total hip replacement, it is essential to differentiate aseptic loosening and infected total hip replacements. The c-reactive protein level and aspiration culture and white blood cell count are crucial parameters to differentiate an aseptic and septic revision. The intraoperative frozen section offers additional information during the procedure. Bone scans, leukocyte scans, and immunoglobulin G scintigraphy are reserved for inconclusive cases. Although Girdlestone resection arthroplasty has been used in the past, two-stage reimplantation is the gold standard for the treatment of infected total hip replacements today. One-stage revision, or debridement without implant removal, might be indicated in selected patients. In life threatening or intractable hip infection, when patient or limb viability is at risk, hip disarticulation should be considered.