Journal Article

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

Whitehouse, Michael R., Whittaker, John-Paul, Bori, Guillem, Lenguerrand, Erik, Wilson, Matthew, Huang, Ronald, MacGowan, Alasdair, Cabo, Javier, Ribera, Alba, Honda, Emerson, Kunutsor, Setor K., Herman, Amir, Rudelli, Sergio, Muñoz-Mahamud, Ernesto, Beswick, Andrew D., Redó, Maria Luisa Sorlí, Dieppe, Paul, Darley, Elizabeth, Jenny, Jean-Yves, Blom, Ashley W., Schwarzkopf, Ran, Burston, Ben, Board, Tim, Parvizi, Javad, Gooberman-Hill, Rachael, Strange, Simon, Kay, Peter, Uip, David E., Cañas, Elena, Cordero-Ampuero, José, Hsieh, Pang-Hsin, Zeller, Valérie, Wroblewski, B. Mike, Masri, Bassam A., Chen, Szu-Yuan, Webb, Jason, Restrepo, Camilo

2018

Overview

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. Reinfection 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 onestage 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.

• Publisher: Springer,Springer Netherlands,Springer Nature B.V
• Subject: Aged / Arthroplasty, Replacement, Hip - adverse effects / Arthroplasty, Replacement, Hip - methods / Cardiology / Chronic infection / Clinical trials / Cohort analysis / Cohort Studies / Continents / Data analysis / Data processing / Epidemiology / Female / Hazards / Hip / Hip Prosthesis - adverse effects / Hip Prosthesis - microbiology / Humans / Infections / Infections - complications / Infections - surgery / Infectious Diseases / Joint diseases / Male / Medical research / Medicine / Medicine & Public Health / META-ANALYSIS / Middle Aged / Observational studies / Oncology / Postoperative Complications - surgery / Proportional Hazards Models / Prostheses / Prosthesis-Related Infections - surgery / Public Health / Reoperation - methods / Reoperation - statistics & numerical data / Subgroups / Treatment Outcome