One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies

Abstract

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.

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…Interestingly, there was no significant difference in the eradication rate between articulating and static spacers in the infected knee replacement [37,38]. The current meta-analysis supports that the infection control or reinfection rate of onestage or two-stage exchange did not significantly differ in the hip, knee, elbow, and shoulder [39][40][41][42][43].…”

“…From 71 publications, 389 keywords were exported. Periprosthetic joint infection (41) was the most commonly used keyword, followed by meta-analysis (29) and total knee arthroplasty (20; Table 8).…”

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…Interestingly, there was no significant difference in the eradication rate between articulating and static spacers in the infected knee replacement [21,22]. The current meta-analysis supports that the infection control or reinfection rate of one-stage or two-stage exchange did not significantly differ in the hip, knee, elbow, and shoulder [23][24][25][26][27].…”

“…For the meta-analysis, 13 software was exported from 106 articles. The most commonly used software was STATA (43), followed by REVMAN (25), and Meta-Disc (21).…”

Primer total diz artroplastisi sonucu oluşan derin enfeksiyonun oluş nedenleri ile güncel tanı ve tedavi yaklaşımları

“…Bu çalışma dahilinde, iki aşamalı revizyon cerrahisi sonrası yineleyen enfeksiyon riskinin tek aşamalı cerrahi geçirenlere göre daha fazla olduğu gösterilmektedir. [123] Enfeksiyonun eradikasyonunda en iyi tedavi seçeneği iki aşamalı revizyon cerrahisinde antibiyotikli kemik çimentosu kullanımı olarak görülmektedir.…”