title: Retrospective analysis of infection rate after early reoperation in total hip arthroplasty.
abstract: BACKGROUND
  Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the fate of these infected hips.
  
  
  OBJECTIVE
  We therefore report the infection rate for patients undergoing THA who returned to the operating room within 90 days of his or her index procedure for any surgical intervention on the same hip.
  
  
  METHODS
  We identified 60 patients undergoing THA referred to or treated at our institution who required an unplanned and unavoidable return to the operating room during the acute recovery phase. The complications of the initial surgery that resulted in reoperation included instability, periprosthetic fracture, retained hardware, and nerve exploration. We then retrospectively reviewed the medical records to determine the infection rate and implant survivorship. The minimum followup was 1 month (average, 3.7 years; range, 1 month to 7 years) and included all patients who required resection before a minimum 2-year followup.
  
  
  RESULTS
  The infection rate for this cohort was 20 of 60 (33%). Six of these 20 retained their implants at 2 years after the reoperation and were considered infection-free. Two-stage reimplantation or resection was eventually performed in 14 of the infected patients.
  
  
  CONCLUSIONS
  A high percentage of patients undergoing THA developed a deep infection after unavoidable reoperation during the acute recovery phase. The reasons for the reoperations were potentially modifiable complications and situations that deserve further investigation to delineate protocols to minimize the risk of infection in these patients.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery-A41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Hussein
authors.initials: H
authors.lastname: Darwiche
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
authors.forename: Alison
authors.initials: A
authors.lastname: Klika
authors.forename: Viktor E
authors.initials: VE
authors.lastname: Krebs
authors.forename: Robert
authors.initials: R
authors.lastname: Molloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors