Revisions for Periprosthetic Hip Infections Do Not Fail More Than Revisions for Aseptic Loosening, but Mortality is Higher

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 rerevisions, and mortality rates between these two cohorts. Methods: By using an arthroplasty registry, revision hips were stratified according to the reasons for revision (aseptic loosening and PHI). Preoperative and intraoperative, demographic 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 preoperative and intraoperative 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 = .51). Half of the rerevisions occurred in the first two years in both the groups. The reasons for rerevision were similar: when rerevision for infection was adopted as an end point, the two cohorts showed nonsignificant differences. The mortality rate was statistically higher in the PHI cohort (P .0015, hazard ratio adjusted for age and gender: 1.42). Conclusion: Aseptic and septic revisions achieved similar outcomes at long-terms, rerevisions tended to fail for the same reason for revision. The mortality rate was significantly higher in the septic cohort. These findings are useful to modify and tune the preoperative, intraoperative, and postoperative managements of revisions.