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Kunutsor SK, Whitehouse MR, Blom AW, Board T, Kay P, Wroblewski BM, Zeller V, Chen SY, Hsieh PH, Masri BA, Herman A, Jenny JY, Schwarzkopf R, Whittaker JP, Burston B, Huang R, Restrepo C, Parvizi J, Rudelli S, Honda E, Uip DE, Bori G, Muñoz-Mahamud E, Darley E, Ribera A, Cañas E, Cabo J, Cordero-Ampuero J, Redó MLS, Strange S, Lenguerrand E, Gooberman-Hill R, Webb J, MacGowan A, Dieppe P, Wilson M, Beswick AD. One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies. Eur J Epidemiol 2018; 33:933-946. [PMID: 29623671 PMCID: PMC6153557 DOI: 10.1007/s10654-018-0377-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/05/2018] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Setor K Kunutsor
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK.
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Tim Board
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | - Peter Kay
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | - B Mike Wroblewski
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| | - Szu-Yuan Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kweishan, 333, Taoyuan, Taiwan
| | - Pang-Hsin Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kweishan, 333, Taoyuan, Taiwan
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, 2775 Laurel St, Vancouver, V5Z 1M9, BC, Canada
| | - Amir Herman
- Department of Orthopaedics, University of British Columbia, 2775 Laurel St, Vancouver, V5Z 1M9, BC, Canada
| | - Jean-Yves Jenny
- Centre for Orthopaedic and Hand Surgery, University Hospital, Strasbourg, 10 Avenue Baumann, 67400, Illkirch, France
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - John-Paul Whittaker
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, SY10 7AG, UK
| | - Ben Burston
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, SY10 7AG, UK
| | - Ronald Huang
- The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - Camilo Restrepo
- The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - Javad Parvizi
- The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - Sergio Rudelli
- Department of Orthopaedic Surgery, Santa Casa Medical School, São Paulo, Brazil
- Institute of Education and Research of Sírio Libanês Hospital, São Paulo, Brazil
| | - Emerson Honda
- Department of Orthopaedic Surgery, Santa Casa Medical School, São Paulo, Brazil
- Institute of Education and Research of Sírio Libanês Hospital, São Paulo, Brazil
| | - David E Uip
- Department of Orthopaedic Surgery, Santa Casa Medical School, São Paulo, Brazil
- Institute of Education and Research of Sírio Libanês Hospital, São Paulo, Brazil
| | - Guillem Bori
- Bone and Joint Infectious Diseases Unit, Department of Orthopaedic and Trauma Surgery, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Ernesto Muñoz-Mahamud
- Bone and Joint Infectious Diseases Unit, Department of Orthopaedic and Trauma Surgery, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Elizabeth Darley
- Severn Pathology Infection Sciences, Pathology Sciences Building, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5ND, UK
| | - Alba Ribera
- Department of Infectious Diseases, IDIBELL, Hospital Universitari de Bellvitge, Feixa Llarga s/n., L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Elena Cañas
- Department of Orthopaedic Surgery, IDIBELL, Hospital Universitari de Bellvitge, Feixa Llarga s/n., L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Javier Cabo
- Department of Orthopaedic Surgery, IDIBELL, Hospital Universitari de Bellvitge, Feixa Llarga s/n., L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - José Cordero-Ampuero
- Cirugía Ortopédica y Traumatología, Hospital Universitario La Princesa, Océano Antártico 41, Tres Cantos, 28760, Madrid, Spain
| | - Maria Luisa Sorlí Redó
- Department of Infectious Diseases, Parc de Salut Mar, Passeig Marítim 25-29, E-08003, Barcelona, Spain
| | - Simon Strange
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK
| | - Jason Webb
- North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Alasdair MacGowan
- Severn Pathology Infection Sciences, Pathology Sciences Building, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5ND, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, EX1 2LU, UK
| | - Matthew Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Southmead Road, Bristol, BS10 5NB, UK
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