Infected total hip replacements pose a diagnostic and management challenge. Careful history, clinical examination, blood tests, plain radiographs and hip aspiration are all part of the clinical assessment. International consensus on establishing the diagnosis helps surgeons to formulate management plans. Management strategies include debridement and prosthesis retention, single-stage revision, two-stage revision, suppressive antibiotic treatment and excision arthroplasty. This article reviews the clinical assessment, diagnosis, principles of surgical management and outcomes of revision surgery of infected total hip replacements.