One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6–20.7) and 32.3 (95% CI 27.3–38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58–5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.Electronic supplementary materialThe online version of this article (10.1007/s10654-018-0377-9) contains supplementary material, which is available to authorized users.

Adherence measurement of treatments is necessary, in spite there are several tools the most of them do not achieve fully the goal. Adherence is a word that includes two concepts: compliance to doses and administration way and persistence on the treatment time. One of these tools is the pharmacy data base. It has been demonstrated using this tool that persistence for osteoporosis patient treatments could be fewer than 25% after one year of prescription. An extended tool is the count of not taked pills that inform of adherence percentage in a period of time. One very useful self- administrated questionnaire is the Morisky-Green with a Spanish version validated by Val Jimenez et al. This questionnaire consists of four simple and short questions. Recently it has been introduced electronic methods that permit to know when and what time the patient takes the pill. Measurement of adherence is not easy and it is necessary to use some tools at the same time to avoid overestimation. Diseases with a long period of treatment as osteoporosis the increase of adherence is needed to prevent fractures.

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This study demonstrated that the influence of sex in lipodystrophy in HIV-infected patients affects not only the lipodystrophy pattern, but also the cardiovascular risk profile.