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

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 HondaDavid 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, Global Infection Orthopaedic Management Collaboration

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

44 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)933-946
Number of pages14
JournalEuropean Journal of Epidemiology
Issue number10
Early online date5 Apr 2018
Publication statusPublished - 1 Oct 2018

Structured keywords

  • Centre for Surgical Research


  • Meta-analysis
  • One-stage
  • Prosthesis related infection
  • Re-infection
  • Reoperation
  • Revision
  • Total hip replacement
  • Two-stage


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