One-stage revision THA yielded efficacy similar to two-stage revision for PJI

Results published in the European Journal of Epidemiology showed one-stage revision total hip arthroplasty for treatment of periprosthetic joint infection was as effective as two-stage revision.

“The one-stage revision strategy for treating an infected hip replacement is as effective as the two-stage strategy, if not better,” Setor K. Kunutsor, Ba(Legon), MBChB(Legon), MA(Cantab), PhD(Cantab), lead author of the study, told Healio.com/Orthopedics. “The one-stage strategy may also be a suitable procedure for patients with certain types of infection or problems that were previously thought not to be appropriate for this type of surgery.”

Using Medline, Embase, Web of Science, The Cochrane Library and the WHO International Clinical Trials Registry Platform, Kunutsor and colleagues analyzed data for 1,856 participants with periprosthetic joint infection (PJI) of the hip who underwent either one-stage (n=884) or two-stage (n=972) revision. The primary outcome was re-infection, which the researchers defined as recurrence of infection by the same organisms or re-infection with a new organism.

Results showed 10% and 13.8% of patients in the one-stage and two-stage group, respectively, experienced a re-infection. Patients who underwent two-stage revision had a greater risk of re-infection vs. patients who underwent one-stage revision, according to results of cumulative hazard curves. Researchers noted a re-infection rate per 1,000 person-years of follow-up of 16.8 for the one-stage revision group and of 32.3 for the two-stage revision group. Researchers found an age-adjusted hazard ratio for re-infection of 1.69 when comparing two-stage revision with one-stage revision among available survival data.

“With these new findings and subsequent adoption of the one-stage strategy by surgeons and hospitals, quality of life could be improved, unnecessary deaths averted and this could all be achieved at a lower cost,” Kunutsor said. – by Casey Tingle

Disclosure s : Kunutsor reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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Source:

Kunutsor SK, et al. Eur J Epidemiol. 2018;doi:10.1007/s10654-018-0377-9.