Revision THA for Aseptic Failure After Two-Stage for PJI: High Rates of Reoperation and Reinfection

Introduction: Data are limited regarding the outcomes of revision total hip arthroplasty (THA) for aseptic failure following eradication of periprosthetic joint infection (PJI) with two-stage exchange. This study aimed to evaluate the mid-term survivorship following revision THA for aseptic failures in patients with a history of two-stage exchange for PJI. Methods: We retrospectively identified 54 aseptic revision THAs performed between 2000-2020 at a single institution in patients who had previously completed ipsilateral two-stage exchange for PJI. Mean age was 63 years, mean BMI was 33 kg/m², and 59% were female. Mean number of previous surgeries before index aseptic revision THA was five. No patients met MSIS criteria for PJI or had positive cultures at the time of “aseptic” revision. The main indications for aseptic revision THA included dislocation (61%), aseptic loosening (19%), and periprosthetic fracture (5%). Mean follow-up was 7 years. Results: The 5-year survivorships free of any reoperation and any revision were 61% and 63%, respectively. The 5-year survivorship free of PJI was 80%. A total of 23 patients underwent reoperation and 43% of these were for PJI (n=10). Eight of the PJI were treated with DAIR and two with implant resection without reimplantation. The three most common indications for subsequent aseptic reoperation were recurrent dislocation (n=7), aseptic loosening (n=4), and periprosthetic fracture (n=2). Conclusion: Revision THA for aseptic failure following two-stage exchange arthroplasty for PJI is associated with a high reoperation rate (39%) and high re-infection rate (20%) at 5 years. These data highlight the importance of maximizing hip stability and ensuring robust fixation at the time of reimplantation to avoid subsequent surgeries that often end in reinfection. While most of the index aseptic revision THAs were for clear indications, these results suggest that surgeons should exercise caution when offering surgery for relative indications in this setting.