title: Revision hip arthroplasty: infection is the most common cause of failure.
abstract: BACKGROUND
  Revision total hip arthroplasty (THA), although relieving pain and restoring function, fails in some patients. In contrast to failures in primary THA, the frequency of the causes of failure in revision THA has been less well established.
  
  
  OBJECTIVE
  We therefore determined the rate of each failure mode and the survivorship of revision THAs.
  
  
  METHODS
  We retrospectively reviewed the charts of 1366 revision THAs performed between 2000 and 2007. There were 609 (44.5%) men and 757 (55.5%) women with a mean age of 66 years. The indications for the revision surgery were mainly aseptic loosening (51%), instability (15%), wear (14%), and infection (8%). The minimum followup was 1 day (mean, 5.5 years; range, 1 day to 9 years).
  
  
  RESULTS
  Two hundred fifty-six of the revisions (18.7%) failed with an average time to failure of 16.6 months (range, 1 day to 7.5 years). Among 256 failed hips, infection was the most common cause of failure (30.2%) followed by instability (25.1%) and aseptic loosening (19.4%). At 5 years, the survivorships of septic and aseptic groups were 67% and 84.8%, respectively. Revision for infection or instability appears to have a considerably lower survivorship when compared to revision for aseptic causes.
  
  
  CONCLUSIONS
  The lower survivorship of revision for infection or instability highlights the importance of implementing better preventative methods that can minimize the impact of these two major causes of failure.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
authors.forename: S Mehdi
authors.initials: SM
authors.lastname: Jafari
authors.forename: Catelyn
authors.initials: C
authors.lastname: Coyle
authors.forename: S M Javad
authors.initials: SM
authors.lastname: Mortazavi
authors.forename: Peter F
authors.initials: PF
authors.lastname: Sharkey
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001424:Bacterial Infections / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery*; D017211:Treatment Failure; D055815:Young Adult