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Lange J, Troelsen A, Thomsen RW, et al. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol. 2012;4:57-73doi: 10.2147/CLEP.S29025.
Lange, J., Troelsen, A., Thomsen, R. W., & Søballe, K. (2012). Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clinical epidemiology, 457-73. https://doi.org/10.2147/CLEP.S29025
Lange, Jeppe, et al. "Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis." Clinical epidemiology vol. 4 (2012): 57-73. doi: https://doi.org/10.2147/CLEP.S29025
Lange J, Troelsen A, Thomsen RW, Søballe K. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol. 2012;4:57-73. doi: 10.2147/CLEP.S29025. Epub 2012 Mar 27. PMID: 22500127; PMCID: PMC3324993.
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Clin Epidemiol. 2012;4:57-73. doi: 10.2147/CLEP.S29025. Epub 2012 Mar 27.

Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis.

Clinical epidemiology

Jeppe Lange, Anders Troelsen, Reimar W Thomsen, Kjeld Søballe

Affiliations

  1. Lundbeck Foundation Center for Fast-Track Hip and Knee Surgery, Aarhus C.

PMID: 22500127 PMCID: PMC3324993 DOI: 10.2147/CLEP.S29025

Abstract

BACKGROUND: Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisions for chronic infection in hip arthroplasties.

METHODS: The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Relevant studies were identified using PubMed and Embase. We assessed studies that included patients with a chronic infection of a hip arthroplasty treated with either one-stage or two-stage revision and with available data on occurrence of reinfections. We performed a meta-analysis estimating absolute risk of reinfection using a random-effects model.

RESULTS: We identified 36 studies eligible for inclusion. None were randomized controlled trials or comparative studies. The patients in these studies had received either one-stage revision (n = 375) or two-stage revision (n = 929). Reinfection occurred with an estimated absolute risk of 13.1% (95% confidence interval: 10.0%-17.1%) in the one-stage cohort and 10.4% (95% confidence interval: 8.5%-12.7%) in the two-stage cohort. The methodological quality of most included studies was considered low, with insufficient data to evaluate confounding factors.

CONCLUSIONS: Our results may indicate three additional reinfections per 100 reimplanted patients when performing a one-stage versus two-stage revision. However, the risk estimates were statistically imprecise and the quality of underlying data low, demonstrating the lack of clear evidence that two-stage revision is superior to one-stage revision among patients with chronically infected hip arthroplasties. This systematic review underscores the need for improvement in reporting and collection of high-quality data and for large comparative prospective studies on this issue.

Keywords: arthroplasty; hip replacement; infection; one-stage; reoperation; two-stage

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