Comparative reinfection rate of one-stage versus two-stage revision in the management of periprosthetic joint infection following total hip arthroplasty: a meta-analysis
Trial registration PROSPERO (CRD42023450842, 17 August 2023) https://www.crd.york.ac.uk/prospero/display_recor d.php?ID=CRD42023450842.
Keywords Total hip arthroplasty, Periprosthetic joint infection, Revision, Infection, Reinfection rate
Abstract
Background Debates persist on the optimal surgical approach for treating Periprosthetic joint infection (PJI) following total hip arthroplasty (THA). This meta-analysis aimed to compare the reinfection rate of one-stage revision versus two-stage revision for PJI after THA.
Methods A comprehensive search was performed in four databases (PubMed, Embase, Web of Science, and Cochrane Library) to locate articles that assessed the reinfection rate of one-stage revision compared to two-stage revision. Meta-analyses of reinfection rate were performed.
Results A total of 14 articles including of 1429 patients were chosen for inclusion in this meta-analysis, with 561 patients in the one-stage group and 868 patients in the two-stage group. The meta-analysis of the 14 trials revealed that there was no statistically significant disparity in the reinfection rate between the two groups(OR=1.34, 95% CI 0.92~1.93, P=0.12, I2=0). A subgroup analysis was conducted based on the presence of a well-defined algorithm for decision making in either a one-stage or two-stage revision. There was no statistically significant difference in reinfection rate between one-stage and two-stage revision if there was a decision algorithm(OR=0.83, 95% CI 0.44~1.54, P=0.55, I2=0). If not, the reinfection rate of one-stage revision was significantly higher than that of twostage revision(OR=1.79, 95% CI 1.11~2.88, P=0.02, I2=0). Postoperative hip function score was significantly better in the one-stage revision group than that of the two-stage revision group(SMD=0.54, 95% CI 0.31~0.78, P<0.05, I 2=79%).
Conclusions A strategy that is clearly defined and can be used for decision making in one-stage or two-stage revision is necessary for the treatment of PJI after THA. When there is significant damage to the soft tissue and/or the presence of strong microorganisms, a two-stage revision is recommended in order to decrease the reinfection rate.
One-stage revision is recommended for patients with low-toxic infections and intact soft tissue.
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