Forty consecutive patients (42 joints; 22 TKA, 20 THA) treated for acute hematogenous infections were reviewed. All patients underwent irrigation and debridement and exchange of the modular components. At a mean of 56 months (range, 25–124 months) recurrent infection, requiring surgery, developed in 9 of the 42 joints (21%); 8 of the 9 recurrent infections were in patients with a staphylococcal infection (P = 0.0004). Ten of the 40 patients (25%) died within 2 years of infection. Irrigation and debridement for the treatment of an acute hematogenous infection was successful in the majority of patients (76% survivorship at 2 years). Non-staphylococcal infections had a particularly low failure rate (96% survivorship at 2 years). The 2 year mortality rate among this subset of patients was strikingly high.