Introduction: Periprosthetic infection is still the most severe complication in THA. In spite of vigorous efforts over the last decades the problem has not been Solved nor minimized. Standardised procedures for prophylaxis and treatment have long been established. Reported results reach into the mid 80% but did not improve remarkably in the last ten years. Our latest follow-up reveals a success rate of 88.6%. A close analysis of the involved unsatisfying cases will help to improve future results.

Material and Methods: 105 consecutive one stage exchanges of THA for periprosthetic infection in 1996 were investigated after 7 years through questionnaire, telephone interview and clinical examination. An overall success rate of 88.6% was found and the failures were analysed. Criteria like age, co morbidities, ASA, duration of infection anamnesis, number of infection related interventions, lab-findings, local findings like fistulas, x-ray rating, operation time, surgeon, complication postoperative and the bacteria involved were compared.

Results: In general it shows that the most desolate cases in all categories line up for a primary failure. The ASA rating is remarkably higher and local findings like fistulas are present in nearly all patients. The bacteria involved are staphylococci in 70%. Over 50% had a combination of two or more pathogens and two patients showed an additional pathogen in the samples taken during the operation. The pattern of the involved bacteria is remarkably severe. But there are also three cases where no sign of higher risk or lower chances could be detected.

Conclusions: Knowing about causes of failure in the specific one stage exchange situation does lead to adaptation in the concept of treatment for those specific cases. With successful application, better results through individual therapy-concepts will be possible.