DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 119
Meta-analysis on risk of reinfection by one-stage vs.
two-stage revision in chronically infected
hip arthroplasties
Jeppe Lange, Anders Troelsen, Kristian Larsen, Kjeld Søballe
Lundbeck Foundation Center for Fast-track Hip and Knee Surgery &
Orthopaedic dep. Regional Hospital; Orthopaedic dep. Hvidovre Hospital;
Lundbeckfoundation Center for Fast-track Hip and Knee Surgery
& Orthopaedic dep. Aarhus University
Background: Internationally the two-stage revision is accepted as gold
surgical standard for treating chronic infections following total hip
arthroplasty (THA). Fast-track treatment is done by one-stage revision,
which is advocated by some international centers. The optimal treatment
strategy for chronically infected THA remains debated
Purpose: We aimed to investigate if one-stage revision is a relevant
treatment strategy, compared to two-stage revision in terms of risk of reinfection
Methods: The meta-analysis was performed in accordance to PRISMA
(www.prisma- statement.org). Studies were identified by searching
Pubmed and Embase with bibliographic cross-reference. Studies were
included for review if eligible according to specified criteria. Analysis
was done using Comprehensive Meta- Analysis software version 2.0. We
estimated risk of reinfections (95% confidence intervals) by randomeffects
model. Statistical significance accepted at p< 0.05
Findings: We used data from 36 eligible studies, pooling 1304 patients
with chronically infected THA and 127 registered reinfections following
reimplantation by either one- or two-stage revision. Reinfection occurs
with an estimated risk of 11 % (9.6 – 13 %). Stratifying by treatment
strategy, reinfection in one- stage revision occurs with an estimated risk
of 13 % (10% -17%) and in two- stage with an estimated risk of 10%
(8.5% - 13%) which did not differ significantly (p-value 0.173). Additional
subgroup or sensitivity analysis did not alter this result. The
methodological quality was considered low in all 36 studies
Conclusion: Although two-stage revision is the gold standard in treating
chronic infections in THA - the quality of evidence is generally poor –
and showed no superiority over one-stage revision
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