Перипротезная инфекция остается одним из наиболее тяжелых осложнений после эндопротезирования тазобедренного сустава, ассоциированным с повторными оперативными вмешательствами, значительными экономическими затратами. Несмотря на совершенствование профилактических мер, частота перипротезной инфекции не демонстрирует тенденции к снижению. Цель статьи – на основе анализа современных литературных данных, включая последние рекомендации профильных обществ и данные мировых регистров, представить всесторонний взгляд на эпидемиологию, факторы риска, диагностику и современные алгоритмы лечения перипротезной инфекции тазобедренного сустава. Поиск актуальной литературы проводился в базах данных Scopus, PubMed, Web of Science. На начальном этапе было проанализировано 167 источников литературы. В окончательный вариант вошло 49 работ, наиболее точно отвечавших на поставленные вопросы. Анализ данных мировых регистров показывает, что частота перипротезной инфекции остается стабильной на протяжении последних десятилетий, при этом абсолютное число случаев растет пропорционально увеличению объема артропластик. Современная диагностика базируется на интеграции клинических, лабораторных, микробиологических и гистологических данных. Выбор хирургической тактики определяется временными критериями, стабильностью имплантата, состоянием мягких тканей и характеристиками возбудителя. Дебридмент с сохранением имплантата показан при острой инфекции со стабильным имплантатом и интактными мягкими тканями. Одноэтапное ревизионное эндопротезирование является эффективной альтернативой двухэтапному при идентифицированном возбудителе и отсутствии резистентности к антибиотикам, обеспечивая сопоставимые показатели эрадикации инфекции с более быстрым функциональным восстановлением и меньшими экономическими затратами. Двухэтапное ревизионное эндопротезирование, традиционно считавшееся «золотым стандартом», в реальной клинической практике его успех во многом зависит от того, как именно оценивать исходы. Ключевым условием успешного лечения является стандартизированная диагностика и выбор оптимальной хирургической стратегии на основе современных клинических рекомендаций.
Periprosthetic joint infection remains one of the most severe complications after hip replacement, associated with repeated surgical interventions and significant economic costs. Despite the improvement of preventive measures, the frequency of periprosthetic joint s does not show a downward trend. The purpose of the article is to present a comprehensive view of epidemiology, risk factors, diagnosis and modern treatment algorithms for hip periprosthetic infection based on the analysis of modern literature data, including the latest recommendations of relevant societies and data from world registries. The search for relevant literature was conducted in the Scopus, PubMed, and Web of Science databases. At the initial stage, 167 literature sources were analyzed. The final version included 49 papers that answered the questions most accurately. Analysis of data from global registries shows that the frequency of periprosthetic joint infection has remained stable over the past decades, while the absolute number of cases is increasing in proportion to the increase in the volume of arthroplasty. Modern diagnosis is based on the integration of clinical, laboratory, microbiological and histological data. The choice of surgical tactics is determined by time criteria, implant stability, soft tissue condition, and pathogen characteristics. Debridement, antimicrobial therapy, and implant retention is indicated for acute infection with a stable implant and intact soft tissues. One-stage revision arthroplasty is an effective alternative to two-stage arthroplasty when the pathogen is identified and there is no resistance to antibiotics, providing comparable infection eradication rates with faster functional recovery and lower economic costs. Two-stage revision hip arthroplasty, traditionally considered the “gold standard,” in real clinical practice its success largely depends on how exactly the outcomes are assessed. The key condition for successful treatment is a standardized diagnosis and the choice of an optimal surgical strategy based on modern clinical recommendations.
1. Learmonth I. D., Young C., Rorabeck C. The operation of the century: total hip replacement // Lancet. 2007. Vol. 370. Is. 9597. P. 1508–1519. DOI: 10.1016/S0140-6736(07)60457-7.
2. Blom A. W., Donovan R. L., Beswick A. D., et al. Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence // BMJ. 2021. Vol. 374. P. n1511. DOI: 10.1136/bmj.n1511.
3. Singh J. A., Yu S., Chen L., Cleveland J. D. Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample // J Rheumatol. 2019. Vol. 46. Is. 9. P. 1134–1140. DOI: 10.3899/jrheum.170990.
4. Shichman I., Roof M., Askew N., et al. Projections and Epidemiology of Primary Hip and Knee Arthroplasty in Medicare Patients to 2040–2060 // JB JS Open Access. 2023. Vol. 8. Is. 1. P. e22.00112. DOI: 10.2106/JBJS.OA.22.00112.
5. Karachalios T., Komnos G., Koutalos A. Total hip arthroplasty: Survival and modes of failure // EFORT Open Rev. 2018. Vol. 3. Is. 5. P. 232–239. DOI: 10.1302/2058-5241.3.170068.
6. Методические руководства. Профилактика инфекций области хирургического вмешательства / Ассоциация «Национальная ассоциация специалистов по контролю инфекционных и неинфекционных болезней» (НАСКИ). Год утверждения: 2023 (пересмотр каждые 3 года). [Электронный ресурс]. URL: https://nasci.confreg.org/libs/files/2._mr_profilaktika_infekciy_oblasti_hirurgicheskogo_vmeshateljstva__2023.pdf (дата обращения: 16.04.2026).
7. Kelmer G., Stone A. H., Turcotte J., King P. J. Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure // J Am Acad Orthop Surg. 2021. Vol. 29. Is. 2. P. 78–87. DOI: 10.5435/JAAOS-D-19-00860.
8. Springer B. D., Cahue S., Etkin C. D., et al. Infection burden in total hip and knee arthroplasties: an international registry-based perspective // Arthroplast Today. 2017. Vol. 3. Is. 2. P. 137–140. DOI: 10.1016/j.artd.2017.05.003.
9. Jafari S. M., Coyle C., Mortazavi S. M., et al. Revision hip arthroplasty: infection is the most common cause of failure // Clin Orthop Relat Res. 2010. Vol. 468. Is. 8. P. 2046–2051. DOI: 10.1007/s11999-010-1251-6.
10. López-Contreras J., Duch Llorach P., Roch Villaverde N., et al. Secular trends in periprosthetic joint infections following primary hip and knee arthroplasties: A 15-year cohort study from the VINCat Program (2008–2022) // Enferm Infecc Microbiol Clin (Engl Ed). 2025. Vol. 43. Suppl 1. P. S44–S51. DOI: 10.1016/j.eimce.2025.02.015.
11. Perni S., Bojan B., Prokopovich P. A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database // PLoS One. 2023. Vol. 18. Is. 3. P. e0282709. DOI: 10.1371/journal.pone.0282709.
12. Всемирная организация здравоохранения. Глобальное руководство по профилактике инфекций в области хирургического вмешательства. Копенгаген: Европейское региональное бюро ВОЗ, 2023. Лицензия: CC BY-NC-SA 3.0 IGO.
13. Alt V., Szymski D., Rupp M., et al. The health-economic burden of hip and knee periprosthetic joint infections in Europe: a comprehensive analysis following primary arthroplasty // Bone Jt Open. 2025. Vol. 6. Is. 3. P. 298–311. DOI: 10.1302/2633-1462.63.BJO-2024-0225.R1.
14. Kanapathy M., Faderani R., Arumugam V., et al. Management of periprosthetic breast infection: a systematic review and meta-analysis // J Plast Reconstr Aesthet Surg. 2021. Vol. 74. Is. 11. P. 2831–2845. DOI: 10.1016/j.bjps.2021.05.070.
15. Rocchi C., Di Maio M., Bulgarelli A., et al. Agreement Analysis Among Hip and Knee Periprosthetic Joint Infections Classifications // Diagnostics (Basel). 2025. Vol. 15. Is. 9. P. 1172. DOI: 10.3390/diagnostics15091172.
16. Goswami K., Clarkson S., Phillips C. D., et al. An Enhanced Understanding of Culture-Negative Periprosthetic Joint Infection with Next-Generation Sequencing: A Multicenter Study // J Bone Joint Surg Am. 2022. Vol. 104. Is. 17. P. 1523–1529. DOI: 10.2106/JBJS.21.01061.
17. Szymski D., Walter N., Straub J., et al. Geringes UKA-Implantationsvolumen, Komorbiditäten, männliches Geschlecht und die Implantation einer gekoppelten TKA sind Risikofaktoren für septische Revisionen nach Knieprothesenimplantation : Eine registerbasierte Studie aus dem Deutschen Endoprothesenregister (EPRD) [Low UKA implantation volume, comorbidities, male sex, and implantation of constrained TKA are risk factors for septic revision after knee arthroplasty implantation: A register-based study from the German Arthroplasty Register] // Orthopadie (Heidelb). 2024. Vol. 53. Is. 11. P. 883–892. DOI: 10.1007/s00132-024-04562-y.
18. Sumi S., Takegami Y., Tokutake K., et al. Risk factors of periprosthetic joint infection after hemiarthroplasty for displaced femoral neck fracture in the elderly: Analysis of 1619 cases in the multicenter database // Injury. 2024. Vol. 55. Is. 7. P. 111603. DOI: 10.1016/j.injury.2024.111603.
19. DeMik D. E., Kohler J. G., Carender C. N., et al. What Is the Impact of Body Mass Index Cutoffs on Total Hip Arthroplasty Complications? // J Arthroplasty. 2022. Vol. 37. Is. 7. P. 1320–1325.e1. DOI: 10.1016/j.arth.2022.03.004.
20. Rubin J., Potluri A. S., Jan K., et al. A Systematic Review and Meta-Analysis of Periprosthetic Joint Infection Rates in Morbidly Obese Patients Undergoing Total Hip Arthroplasty // J Am Acad Orthop Surg Glob Res Rev. 2025. Vol. 9. Is. 4. P. e24.00306. DOI: 10.5435/JAAOSGlobal-D-24-00306.
21. Сиваконь С. В., Сретенский С. В., Митрофанова Н. Н. и др. Основные возбудители и значение перипротезной инфекции в современной ортопедии // Хирургическая практика. 2024. № 2. С. 55–68. DOI: 10.5922/2223-2427-2024-9-2-4.
22. Chang W. P., Peng Y. X. Differences Between Patients With Diabetes Mellitus and Obese Patients in Occurrence of Peri-Prosthetic Joint Infection: A Systemic Review and Meta-Analysis // Surg Infect (Larchmt). 2023. Vol. 24. Is. 8. P. 671–683. DOI: 10.1089/sur.2023.139.
23. Li Y., Quan X., Zhou C., et al. Risk factors for metachronous periprosthetic joint infection in patients with multiple prosthetic joints: a systematic review and meta-analysis // J. Orthop Surg Res. 2025. Vol. 20. Is. 1. P. 293. DOI: 10.1186/s13018-025-05694-3.
24. Mahase E. Rheumatoid arthritis: glucocorticoids are associated with nearly double infection risk post-surgery // BMJ. 2019. Vol. 365. P. l2271. DOI: 10.1136/bmj.l2271.
25. George M. D., Baker J. F., Winthrop K., et al. Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty: A Cohort Study // Ann Intern Med. 2019. Vol. 170. Is. 12. P. 825–836. DOI: 10.7326/M18-2217.
26. Gerow D., Zheng H., Hughes R., Johnson K., Hallstrom B. A novel preoperative calculator for periprosthetic joint infection following total joint arthroplasty based off the marcqi database // SMRJ. 2024.Vol. 9. Is. 2. Р. 29. DOI:10.51894/001c.122804.
27. Hu Lifeng, Fu Jun, Zhou Yonggang, et al. Trends in Microbiological Profiles and Antibiotic Resistance in Periprosthetic Joint Infections // Journal of International Medical Research. 2021. Vol. 49. Is. 3. DOI: 10.1177/03000605211002784.
28. Egerci O. F., Yapar A., Dogruoz F., et al. Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review // Arch Orthop Trauma Surg. 2024. Vol. 144. Is. 12. P. 5131–5146. DOI: 10.1007/s00402-024-05301-w.
29. Lewis D. P., Tarrant S. M., Dewar D., Balogh Z. J. Periprosthetic joint infection after hemiarthroplasty for hip fracture is a distinct clinical entity associated with high mortality // Bone Jt Open. 2025. Vol. 6. Is. 11. P. 1409–1415. DOI: 10.1302/2633-1462.611.BJO-2025-0120.R1.
30. Sandu E. C., Cirstoiu C., Iordache S., et al. The Ongoing Struggle to Find a Gold Standard for PJI Diagnosis // Reports (MDPI). 2025. Vol. 8. Is. 3. P. 155. DOI: 10.3390/reports8030155.
31. Streck L. E., Sterneder C. M., Haralambiev L., et al. Correction: Significant differences in the rate of periprosthetic joint infections in revision hip and knee arthroplasty depending on the applied definition // Arch Orthop Trauma Surg. 2025. Vol. 145. Is. 1. P. 516. DOI: 10.1007/s00402-025-06076-4.
32. Pascal A., Lambrey P. J., Valentin B., et al. Comparative performance analysis of Synovasure™ and Leukocyte Esterase assays for the diagnosis of periprosthetic infections in complex microbiological situations // Orthop Traumatol Surg Res. 2025. Vol. 111. Is. 6. P. 104046. DOI: 10.1016/j.otsr.2024.104046.
33. Maritati M., De Rito G., Zanoli G. A., et al. Beyond Cultures: The Evolving Role of Molecular Diagnostics, Synovial Biomarkers and Artificial Intelligence in the Diagnosis of Prosthetic Joint Infections // J. Clin Med. 2025. Vol. 14. Is. 19. P. 6886. DOI: 10.3390/jcm14196886.
34. Matsen Ko L., Parvizi J. Diagnosis of Periprosthetic Infection: Novel Developments // Orthop Clin North Am. 2016. Vol. 47. Is. 1. P. 1–9. DOI: 10.1016/j.ocl.2015.08.003.
35. Bémer P., Plouzeau-Jayle C., Lemarié C., et al. Best microbiological practice recommendations for the diagnosis of peri-prosthetic joint infections: the CRIOGO bacteriology reference center network // Ann Clin Microbiol Antimicrob. 2025. Vol. 24. Is. 1. P. 61. DOI: 10.1186/s12941-025-00831-6.
36. Zhao M. Y., Girgis S., Goldade T., et al. Comparative Diagnostic Value of Serological and Synovial Tests for Periprosthetic Joint Infections: A Comprehensive Analysis // JB JS Open Access. 2025. Vol. 10. Is. 2. P. e24.00206. DOI: 10.2106/JBJS.OA.24.00206.
37. Denyer S., Eikani C., Sheth M., et al. Utility of Blood Cell Ratio Combinations for Diagnosis of Periprosthetic Joint Infection // Arthroplast Today. 2023. Vol. 23. P. 101195. DOI: 10.1016/j.artd.2023.101195.
38. Indelli P. F., Totlis T., Lovreković B., et al. Molecular diagnostics for perioperative microbial identification in periprosthetic joint infection: A scoping review and proposal of a diagnostic flow chart // J Exp Orthop. 2025. Vol. 12. Is. 2. P. e70263. DOI: 10.1002/jeo2.70263.
39. Hewlett A. L., Kildow B. J., Cortés-Penfield N. W. Periprosthetic Joint Infections // Infect Dis Clin North Am. 2025. Vol. 39. Is. 3. P. 399–417. DOI: 10.1016/j.idc.2025.02.010.
40. Sigmund I. K., Ferry T., Sousa R., et al. Debridement, antimicrobial therapy, and implant retention (DAIR) as curative strategy for acute periprosthetic hip and knee infections: a position paper of the European Bone & Joint Infection Society (EBJIS) // J Bone Jt Infect. 2025. Vol. 10. Is. 2. P. 101–138. DOI: 10.5194/jbji-10-101-2025.
41. Bryan A. J., Abdel M. P., Sanders T. L., et al. Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management // J Bone Joint Surg Am. 2017. Vol. 99. № 23. P. 2011–2018. DOI: 10.2106/JBJS.16.01103.
42. Xu Y., Wang L., Xu W. Risk factors affect success rate of debridement, antibiotics and implant retention (DAIR) in periprosthetic joint infection // Arthroplasty. 2020. Vol. 2. Is. 1. P. 37. DOI: 10.1186/s42836-020-00056-2.
43. Clauss M., Hunkeler C., Manzoni I., Sendi P. Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection // J Bone Jt Infect. 2020. Vol. 5. Is. 1. P. 35–42. DOI: 10.7150/jbji.40924.
44. Salman L. A., Altahtamouni S. B., Khatkar H., et al. Success rate of single versus multiple debridement, antibiotics, and implant retention (DAIR) in hip and knee periprosthetic joint infection: a systematic review and meta-analysis // Eur J Orthop Surg Traumatol. 2024. Vol. 34. Is. 8. P. 3859–3872. DOI: 10.1007/s00590-024-04091-6.
45. Kushwaha N. S., Pushprajan, Ojha A., et al. Infection management in hip arthroplasty: Comparative insights on revision strategies // J Clin Orthop Trauma. 2025. Vol. 68. P. 103079. DOI: 10.1016/j.jcot.2025.103079.
46. Tan T. L., Goswami K., Fillingham Y. A., et al. Defining Treatment Success After 2-Stage Exchange Arthroplasty for Periprosthetic Joint Infection // J Arthroplasty. 2018. Vol. 33. Is. 11. P. 3541–3546. DOI: 10.1016/j.arth.2018.06.015.
47. Tubin N., Bonello J. P., Abdelbary H., et al. Lower Reported Success Rates of Two-Stage Revisions for Periprosthetic Joint Infections Using Musculoskeletal Infection Society Outcome Reporting Tool at a Specialty Referral Center // J. Arthroplasty 2025 Oct. Vol. 15. S0883-5403(25)01307-5. DOI: 10.1016/j.arth.2025.10.031.
48. Ryan S. P., Warne C. N., Osmon D. R., et al. Short Course of Oral Antibiotic Treatment After Two-Stage Exchange Arthroplasty Appears to Decrease Early Reinfection // J. Arthroplasty. 2023. Vol. 38. Is. 5. P. 909–913. DOI: 10.1016/j.arth.2022.12.006.
49. Humphries H., Wignadasan W., Fontalis A., et al. Single-Stage Revision for Treatment of Prosthetic Joint Infection in Total Hip Arthroplasty // Indian J Orthop. 2025. Vol. 59. Is. 7. P. 901–909. DOI: 10.1007/s43465-025-01405-6.