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One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies |
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| Authors: | Setor K. Kunutsor Michael R. Whitehouse Ashley W. Blom Tim Board Peter Kay B. Mike Wroblewski Valérie Zeller Szu-Yuan Chen Pang-Hsin Hsieh Bassam A. Masri Amir Herman Jean-Yves Jenny Ran Schwarzkopf John-Paul Whittaker Ben Burston Ronald Huang Camilo Restrepo Javad Parvizi Sergio Rudelli Emerson Honda David E. Uip Guillem Bori Ernesto Muñoz-Mahamud Elizabeth Darley Alba Ribera Elena Cañas Javier Cabo José Cordero-Ampuero Maria Luisa Sorlí Redó Simon Strange Erik Lenguerrand Rachael Gooberman-Hill Jason Webb Alasdair MacGowan Paul Dieppe Matthew Wilson Andrew D. Beswick The Global Infection Orthopaedic Management Collaboration |
| Affiliation: | 1.Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital,University of Bristol,Bristol,UK;2.National Institute for Health Research Bristol Biomedical Research Centre,University of Bristol,Bristol,UK;3.Wrightington, Wigan and Leigh NHS Foundation Trust,Appley Bridge, Wigan,UK;4.Centre de Référence des Infections Ostéo-Articulaires Complexes,Groupe Hospitalier Diaconesses-Croix Saint-Simon,Paris,France;5.Department of Orthopaedic Surgery, Chang Gung Memorial Hospital,Chang Gung University College of Medicine,Kweishan,Taiwan;6.Department of Orthopaedics,University of British Columbia,Vancouver,Canada;7.Centre for Orthopaedic and Hand Surgery,University Hospital, Strasbourg,Illkirch,France;8.Division of Adult Reconstruction, Department of Orthopedics, NYU Langone Medical Center,Hospital for Joint Diseases,New York,USA;9.Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust,Oswestry,UK;10.The Rothman Institute of Orthopaedics,Thomas Jefferson University Hospital,Philadelphia,USA;11.Department of Orthopaedic Surgery,Santa Casa Medical School,S?o Paulo,Brazil;12.Institute of Education and Research of Sírio Libanês Hospital,S?o Paulo,Brazil;13.Bone and Joint Infectious Diseases Unit, Department of Orthopaedic and Trauma Surgery, IDIBAPS, Hospital Clinic of Barcelona,University of Barcelona,Barcelona,Spain;14.Severn Pathology Infection Sciences, Pathology Sciences Building, North Bristol NHS Trust,Southmead Hospital,Westbury-on-Trym, Bristol,UK;15.Department of Infectious Diseases, IDIBELL,Hospital Universitari de Bellvitge,Barcelona,Spain;16.Department of Orthopaedic Surgery, IDIBELL,Hospital Universitari de Bellvitge,Barcelona,Spain;17.Cirugía Ortopédica y Traumatología,Hospital Universitario La Princesa,Madrid,Spain;18.Department of Infectious Diseases,Parc de Salut Mar,Barcelona,Spain;19.North Bristol NHS Trust,Southmead Hospital,Bristol,UK;20.Medical School,University of Exeter,Exeter,UK;21.Princess Elizabeth Orthopaedic Centre,Royal Devon and Exeter NHS Foundation Trust,Exeter,UK |
| 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. |
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