Purpose: The purpose of this study was to assess preoperative bone stock and immediate postoperative cement-bone interface as factors affecting infection control and mechanical outcome after one stage revision total hip replacement (THR) for deep infection.

Material and methods: This study included 115 cases which satisfied following conditions; a) One stage revision THRs for deep infection were carried out by a single surgeon (BMW). b) Follow-up of more than five years was possible. c) Complete series of radiographs were available including preoperative, immediate postoperative and the latest follow-up ones. Preoperative bone stock was classified into four grades (Grade 0: No bone loss, Grade 1: Demarcation, Grade 2: Localized cavitation, Grade 3: Significant bone loss). Immediate postoperative cement-bone interface was also graded into four categories (Grade A: White-out, obscure interface, Grade B: Clear line, no measurable gap, Grade C: Gap> 1mm, Grade D< 1mm). These two factors were analysed in view of infection control and mechanical survival of implants after surgery.

Results: Preoperative bone stock did not show significant influence on infection control while it affected mechanical outcome. Immediate postoperative cement-bone interface was an affecting factor for not only mechanical survival of implants but cure of infection.

Conclusion: Preoperative bone stock and immediate postoperative cement-bone interface were assessed as influential factors in one stage revision THR for deep infection. There was a good chance of cure of infection even in cases with significant bone loss. Good cement fixation appeared to be important in view of infection control as well as mechanical survival of implants.

Deep infection is one of the most serious complications after total hip replacement (THR). The aim of this study is to evaluate the efficacy of one stage revision THR for deep infection with a long-term follow-up.

One stage revision THR for deep infection was carried out in 285 joints on 274 patients by a single surgeon (BMW) between 1974 and 2001. All infected hip replacements are primarily treated with one stage revision THR at the authors’ unit unless bone stock is extremely poor. This study included a review of 162 revisions in 154 for which a minimum follow-up of five years had been done. The mean duration of follow-up was 12.3 years.

Trochanteric osteotomy was done for extensive resection of infected tissue and removal of cement. Both cups and stems were revised with bone cement. Antibiotic-loaded cement was used in 152 cases (93.8%). Further antibiotics were commenced systemically for 6–12 weeks postoperatively.

Failure of infection control was defined as a) reoperation for recurrent infection or b) clinically persistent infection. Infection control. One hundred and thirty eight hips (85.2%) were free of infection at the time of the latest follow-up. 1) No sinus group (N=110): Success rate was 82.7 %. 2) Sinus group (N=52): Success rate was 90.4 %.

This study presents the longest follow-up with a large number of cases in revision THR for deep infection. At least, history of discharging sinus was not considered as a contraindication. The results suggested that one stage revision was an effective treatment for deep infection of hip replacement in the long term.