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Meta-Analysis
. 2023 Feb;143(2):829-838.
doi: 10.1007/s00402-021-04190-7. Epub 2021 Sep 30.

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Annemarie L Goud  1 , Netanja I Harlianto  2 , Solaiman Ezzafzafi  3 , Ewout S Veltman  3 , Joris E J Bekkers  1 , Bart C H van der Wal  3
Affiliations
Meta-Analysis

Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

Annemarie L Goud et al. Arch Orthop Trauma Surg. 2023 Feb.

Abstract

Purpose: Revisions for periprosthetic joint infection of knee and hip arthroplasty can be performed following one- or two-stage treatment protocols. Current literature is inconclusive whether one protocol is superior to the other, as prior literature reported similar reinfection rates for both treatment options. We aimed to provide a systematic review and meta-analysis of current literature on septic arthroplasty revisions.

Methods: Between April 2015 and December 2020, Medline, Embase, and The Cochrane Library were searched for studies reporting reinfection outcomes in patients treated with one-stage and two-stage knee or hip revision arthroplasty. Two reviewers independently extracted data and disagreements were resolved by a third investigator. We utilized a double arcsine transformation, prior to pooling using a random-effects model.

Results: For hip revision arthroplasty, we identified 14 one-stage studies (n = 1237) with a pooled reinfection rate of 5.7% (95% CI 3.7-8.1%), and 46 two-stage studies (n = 5009) with a reinfection rate of 8.4% (95% CI 6.9-9.9%). For knee revision arthroplasty, 6 one-stage studies (n = 527) and 48 two-stage studies (n = 4344) were identified with reinfection rates of 12.7% (7.0-19.7%) and 16.2% (13.7-19.0%), respectively. Overall, reinfection rates did not vary substantially after subgroup analysis. Limitations of our study are the limited amount of one-stage studies that introduce a potential bias.

Conclusion: The reinfection rates following one- and two-stage hip and knee arthroplasty revisions were similar. Knee reinfection rates have increased compared to the previous analysis. Individual patient characteristics and adequate treatment algorithms are needed for a more individual selection approach, until a randomized trial is performed.

Keywords: Arthroplasty; One-stage; Periprosthetic joint infection; Reinfection; Revision arthroplasty; Two-stage.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of study selection
Fig. 2
Fig. 2
Forest plot for one-stage hip revision reinfection rates presented with 95% confidence intervals (95% CI)
Fig. 3
Fig. 3
Forest plot for two-stage hip revision reinfection rates presented with 95% confidence intervals (95% CI)
Fig. 4
Fig. 4
Forest plot for one-stage knee revision reinfection rates presented with 95% confidence intervals (95% CI)
Fig. 5
Fig. 5
Forest plot for two-stage knee revision reinfection rates presented with 95% confidence intervals (95% CI)
See this image and copyright information in PMC

References

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