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One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

ABSTRACT: 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.

SUBMITTER: Kunutsor SK

PROVIDER: S-EPMC6153557 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

Kunutsor Setor K SK Whitehouse Michael R MR Blom Ashley W AW Board Tim T Kay Peter P Wroblewski B Mike BM Zeller Valérie V Chen Szu-Yuan SY Hsieh Pang-Hsin PH Masri Bassam A BA Herman Amir A Jenny Jean-Yves JY Schwarzkopf Ran R Whittaker John-Paul JP Burston Ben B Huang Ronald R Restrepo Camilo C Parvizi Javad J Rudelli Sergio S Honda Emerson E Uip David E DE Bori Guillem G Muñoz-Mahamud Ernesto E Darley Elizabeth E Ribera Alba A Cañas Elena E Cabo Javier J Cordero-Ampuero José J Redó Maria Luisa Sorlí MLS Strange Simon S Lenguerrand Erik E Gooberman-Hill Rachael R Webb Jason J MacGowan Alasdair A Dieppe Paul P Wilson Matthew M Beswick Andrew D AD

European journal of epidemiology 20180405 10

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 ret ...[more]

PMID: 29623671

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Project description:BackgroundHip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with historic controls.MethodsWe evaluated the national joint registries of 5 health systems (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR]; National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man; New Zealand Joint Registry [NZJR]; Swedish Hip Arthroplasty Register [SHAR] and Swedish Knee Arthroplasty Register [SKAR]; and the American Joint Replacement Registry [AJRR]) for hip and knee revision burden over the past 4 years or since registry inception. Historic controls were obtained from previously published reports.ResultsThe 2014 hip revision burden varied from 9.7 percent (NJR) to 11.9 percent (NZJR), and the unweighted average was 10.4 percent. The 2011, 2012, and 2013 mean hip revision burden was 11.9, 11.9, and 11.4 percent. The 2014 knee revision burden varied from to 6.0 percent (NJR) to 8.1 percent (AJRR), and the unweighted average for the 5 registries studied was 7.0 percent. The 2011, 2012, and 2013 mean knee revision burden was 6.9, 7.0, and 7.0 percent. Historically, the observed hip revision burden was 15.8 percent and the knee revision burden 8.0 percent.ConclusionsRevision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.

Dataset Information

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

Publications

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

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