One-Stage Versus Two-Stage Revision Surgery for Periprosthetic Hip Infection: An Updated Systematic Review and Meta-Analysis of Clinical Outcomes

Autores de IIS La Fe

• Gonzalo Mariscal Ruiz-Rico

  Autor

Participantes ajenos a IIS La Fe

• Lamo-Espinosa J.M.
• Gómez-Álvarez J.
• Font-Vizcarra L.
• Del Pozo J.L.
• San-Julián M.

Grupos

• Cirugía Ortopédica y Traumatología

Abstract

Introduction:The primary objective of this meta-analysis was to evaluate and compare the functional outcomes, postoperative reinfection rates, and complication rates in patients undergoing one-stage versus two-stage surgical revision for periprosthetic hip infection.Methods:The study population included adult patients who had undergone revision hip arthroplasty. Comparative studies have compared two-stage and one-stage revision strategies. Searches were conducted using the major databases. Review Manager software was used to estimate the effects. A sensitivity analysis was also conducted.Results:Nine cohort studies including 2,502 hips were included. The success rate did not show significant differences between the groups (odds ratio [OR] 0.42, 95% confidence interval 0.05 to 3.37). No difference was noted in reinfection (OR 0.81, 95% CI 0.56-1.19). Life quality per Harris Hip Score was higher for one-stage revision strategies (mean difference [MD] 9.00, 95% CI 2.23-15.78). No differences were noted in mortality, aseptic loosening, or revision rates. Age (MD 2.32, 95% CI 1.34-3.29) and body mass index (BMI) (MD 1.88, 95% CI 0.38-3.38) were lower in the two-stage group. Sinus tract presence was higher in the one-stage group (OR 1.44, 95% CI 1.05-1.95). Paprosky I acetabulum was higher in the one-stage group, and Paprosky III was higher in the two-stage group.Conclusions:The results did not demonstrate notable clinical differences between one-stage and two-stage hip arthroplasties, regardless of the treated microorganism. However, the quality of life may be somewhat better in the one-stage group. Age, body mass index, and Paprosky classification are factors that influence procedure selection. © American Academy of Orthopaedic Surgeons.

Keywords

• Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Postoperative Complications; Prosthesis-Related Infections; Quality of Life; Reinfection; Reoperation; Treatment Outcome; adverse event; comparative study; etiology; hip prosthesis; hip replacement; human; meta analysis; postoperative complication; procedures; prosthesis infection; quality of life; reinfection; reoperation; surgery; treatment outcome