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. 2019 Apr 10;8(4):485.
doi: 10.3390/jcm8040485.

Similar Risk of Re-Revision in Patients after One- or Two-Stage Surgical Revision of Infected Total Hip Arthroplasty: An Analysis of Revisions in the Swedish Hip Arthroplasty Register 1979⁻2015

Karin Svensson  1   2   3 , Ola Rolfson  1   2   3 , Johan Kärrholm  1   2   3 , Maziar Mohaddes  1   2   3
Affiliations

Similar Risk of Re-Revision in Patients after One- or Two-Stage Surgical Revision of Infected Total Hip Arthroplasty: An Analysis of Revisions in the Swedish Hip Arthroplasty Register 1979⁻2015

Karin Svensson et al. J Clin Med. .

Abstract

Late chronic infection is a devastating complication after total hip arthroplasty (THA) and is often treated with surgery. The one-stage surgical procedure is believed to be the more advantageous from a patient and cost perspective, but there is no consensus on whether the one- or two-stage procedure is the better option. We analysed the risk for re-revision in infected primary THAs repaired with either the one- or two-stage method. Data was obtained from the Swedish Hip Arthroplasty Register and the study groups were patients who had undergone a one-stage (n = 404) or two-stage (n = 1250) revision due to infection. Risk of re-revision was analysed using Kaplan-Meier analysis with log-rank test and Cox regression analysis. The cumulative survival rate was similar in the two groups at 15 years after surgery (p = 0.1). Adjusting for covariates, the risk for re-revision due to all causes did not differ between patients who were operated on with the one- or two-stage procedure (Hazard Ratio (HR) = 0.9, 95% Confidence Interval (C.I.) = 0.7-1.2, p = 0.5). The risk for re-revision due to infection (HR = 0.7, 95% C.I. = 0.4-1.1, p = 0.2) and aseptic loosening (HR = 1.2, 95% C.I. = 0.8-1.8, p = 0.5) was similar. This study could not determine whether the one-stage method was inferior in cases when the performing surgeons chose to use the one-stage method.

Keywords: hip arthroplasty; infection; revision surgery.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
The distribution of one- and two-stage procedures in Sweden during 1979–2015.
Figure 2
Figure 2
Kaplan-Meier survival analysis comparing the one- and two-stage procedure using re-revision due to all causes as an endpoint. The cumulative survival rate at 15 years after surgery was found to be similar between the two procedures (p = 0.13).
Figure 3
Figure 3
The cumulative survival rate at 15 years after surgery using re-revision due to infection as the endpoint. The survival rate was similar between the one- and two-stage procedures (p = 0.13).
Figure 4
Figure 4
The cumulative survival rate at 15 years after surgery for the one- and two-stage group was similar (p = 0.87) when analysed for re-revision due to aseptic loosening.
See this image and copyright information in PMC

References

    1. Ong K.L., Kurtz S.M., Lau E., Bozic K.J., Berry D.J., Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J. Arthroplast. 2009;24:105–109. doi: 10.1016/j.arth.2009.04.027. - DOI - PubMed
    1. Blom A.W., Taylor A.H., Pattison G., Whitehouse S., Bannister G.C. Infection after total hip arthroplasty. The Avon experience. J. Bone Joint Surg. Br. 2003;85:956–959. doi: 10.1302/0301-620X.85B7.14095. - DOI - PubMed
    1. Garellick G., Kärrholm J., Lindahl H., Malchau H., Rogmark C., Rolfson O. The Swedish Hip Arthroplasty Register, Annual Report 2013. [(accessed on 27 July 2015)]; Available online: https://registercentrum.blob.core.windows.net/shpr/r/Annual-report-2013-....
    1. Andersson A.E., Bergh I., Karlsson J., Nilsson K. Patients’ experiences of acquiring a deep surgical site infection: An interview study. Am. J. Infect. Control. 2010;38:711–717. doi: 10.1016/j.ajic.2010.03.017. - DOI - PubMed
    1. Zmistowski B., Karam J.A., Durinka J.B., Casper D.S., Parvizi J. Periprosthetic joint infection increases the risk of one-year mortality. J. Bone Joint Surg. Am. 2013;95:2177–2184. doi: 10.2106/JBJS.L.00789. - DOI - PubMed

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