TY - JOUR
T1 - One- and two-stage surgical revision of peri-prosthetic joint infection of the hip
T2 - a pooled individual participant data analysis of 44 cohort studies
AU - Kunutsor, Setor K
AU - Whitehouse, Michael R
AU - Blom, Ashley W
AU - Board, Tim
AU - Kay, Peter
AU - Wroblewski, B Mike
AU - Zeller, Valérie
AU - Chen, Szu-Yuan
AU - Hsieh, Pang-Hsin
AU - Masri, Bassam A
AU - Herman, Amir
AU - Jenny, Jean-Yves
AU - Schwarzkopf, Ran
AU - Whittaker, John-Paul
AU - Burston, Ben
AU - Huang, Ronald
AU - Restrepo, Camilo
AU - Parvizi, Javad
AU - Rudelli, Sergio
AU - Honda, Emerson
AU - Uip, David E
AU - Bori, Guillem
AU - Muñoz-Mahamud, Ernesto
AU - Darley, Elizabeth
AU - Ribera, Alba
AU - Cañas, Elena
AU - Cabo, Javier
AU - Cordero-Ampuero, José
AU - Redó, Maria Luisa Sorlí
AU - Strange, Simon
AU - Lenguerrand, Erik
AU - Gooberman-Hill, Rachael
AU - Webb, Jason
AU - MacGowan, Alasdair
AU - Dieppe, Paul
AU - Wilson, Matthew
AU - Beswick, Andrew D
AU - Global Infection Orthopaedic Management Collaboration
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
AB - 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.
KW - Meta-analysis
KW - One-stage
KW - Prosthesis related infection
KW - Re-infection
KW - Reoperation
KW - Revision
KW - Total hip replacement
KW - Two-stage
UR - http://www.scopus.com/inward/record.url?scp=85045054283&partnerID=8YFLogxK
U2 - 10.1007/s10654-018-0377-9
DO - 10.1007/s10654-018-0377-9
M3 - Article (Academic Journal)
C2 - 29623671
SN - 0393-2990
VL - 33
SP - 933
EP - 946
JO - European Journal of Epidemiology
JF - European Journal of Epidemiology
IS - 10
ER -
