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Meta-Analysis
. 2015 Sep 25;10(9):e0139166.
doi: 10.1371/journal.pone.0139166. eCollection 2015.

Re-Infection Outcomes following One- and Two-Stage Surgical Revision of Infected Hip Prosthesis: A Systematic Review and Meta-Analysis

Setor K Kunutsor  1 , Michael R Whitehouse  1 , Ashley W Blom  1 , Andrew D Beswick  1 ; INFORM Team
Affiliations
Meta-Analysis

Re-Infection Outcomes following One- and Two-Stage Surgical Revision of Infected Hip Prosthesis: A Systematic Review and Meta-Analysis

Setor K Kunutsor et al. PLoS One. .

Abstract

Background: The two-stage revision strategy has been claimed as being the "gold standard" for treating prosthetic joint infection. The one-stage revision strategy remains an attractive alternative option; however, its effectiveness in comparison to the two-stage strategy remains uncertain.

Objective: To compare the effectiveness of one- and two-stage revision strategies in treating prosthetic hip infection, using re-infection as an outcome.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, EMBASE, Web of Science, Cochrane Library, manual search of bibliographies to March 2015, and email contact with investigators.

Study selection: Cohort studies (prospective or retrospective) conducted in generally unselected patients with prosthetic hip infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision. No clinical trials were identified.

Review methods: Data were extracted by two independent investigators and a consensus was reached with involvement of a third. Rates of re-infection from 38 one-stage studies (2,536 participants) and 60 two-stage studies (3,288 participants) were aggregated using random-effect models after arcsine transformation, and were grouped by study and population level characteristics.

Results: In one-stage studies, the rate (95% confidence intervals) of re-infection was 8.2% (6.0-10.8). The corresponding re-infection rate after two-stage revision was 7.9% (6.2-9.7). Re-infection rates remained generally similar when grouped by several study and population level characteristics. There was no strong evidence of publication bias among contributing studies.

Conclusion: Evidence from aggregate published data suggest similar re-infection rates after one- or two-stage revision among unselected patients. More detailed analyses under a broader range of circumstances and exploration of other sources of heterogeneity will require collaborative pooling of individual participant data.

Systematic review registration: PROSPERO 2015: CRD42015016559.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection of studies included in the meta-analysis.
Fig 2
Fig 2. Rates of re-infection in unselected patients treated by one-stage revision.
The summary estimates presented were calculated using random effects models; CI, confidence interval (bars).
Fig 3
Fig 3. Rate of re-infection in unselected patients treated by two-stage revision.
The summary estimates presented were calculated using random effects models; CI, confidence interval (bars).
See this image and copyright information in PMC

References

    1. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351(16):1645–54. 10.1056/NEJMra040181 - DOI - PubMed
    1. Andersson AE, Bergh I, Karlsson J, Nilsson K. Patients' experiences of acquiring a deep surgical site infection: An interview study. Am J Infect Control. 2010;38(9):711–7. 10.1016/j.ajic.2010.03.017 - DOI - PubMed
    1. Hunter G, Dandy D. The natural history of the patient with an infected total hip replacement. J Bone Joint Surg Am. 1977;59-B(3):293–7. - PubMed
    1. Laffer RR, Graber P, Ochsner PE, Zimmerli W. Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect. 2006;12(5):433–9. . - PubMed
    1. Del Pozo JL, Patel R. Infection Associated with Prosthetic Joints. New England Journal of Medicine. 2009;361(8):787–94. ISI:000269081200007. 10.1056/NEJMcp0905029 - DOI - PMC - PubMed

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