Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review.

D A George,L Drago,C L Romano,S Gianola,F S Haddad,G Castellini,S Scarponi,N Logoluso

doi:10.1186/s12879-016-1869-4

Abstract

BackgroundThe best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies. The aim of this systematic review is to compare the infection recurrence rate after a single-stage versus a two-stage exchange arthroplasty, and the rate of cemented versus cementless single-stage exchange arthroplasty for chronic periprosthetic hip infections.MethodsWe searched for eligible studies published up to December 2015. Full text or abstract in English were reviewed. We included studies reporting the infection recurrence rate as the outcome of interest following single- or two-stage exchange arthroplasty, or both, with a minimum follow-up of 12 months. Two reviewers independently abstracted data and appraised quality assessment.ResultsAfter study selection, 90 observational studies were included. The majority of studies were focused on a two-stage hip exchange arthroplasty (65 %), 18 % on a single-stage exchange, and only a 17 % were comparative studies. There was no statistically significant difference between a single-stage versus a two-stage exchange in terms of recurrence of infection in controlled studies (pooled odds ratio of 1.37 [95 % CI = 0.68-2.74, I2 = 45.5 %]).Similarly, the recurrence infection rate in cementless versus cemented single-stage hip exchanges failed to demonstrate a significant difference, due to the substantial heterogeneity among the studies.ConclusionDespite the methodological limitations and the heterogeneity between single cohorts studies, if we considered only the available controlled studies no superiority was demonstrated between a single- and two-stage exchange at a minimum of 12 months follow-up. The overalapping of confidence intervals related to single-stage cementless and cemented hip exchanges, showed no superiority of either technique.

Highlights

The best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies
There remains an ongoing discrepancy in the literature between the infection recurrence rates after a single-stage exchange arthroplasty compared to a two-stage exchange for chronic periprosthetic hip infections
In the lack of large prospective, randomised controlled comparative trials, this comprehensive systematic review and meta-analysis of observational studies was undertaken to investigate the relative efficacy, in terms of recurrence of the infection, in a single- compared to two-stage exchange arthroplasty for chronic periprosthetic hip infection

Summary

Introduction

The best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies. The aim of this systematic review is to compare the infection recurrence rate after a single-stage versus a two-stage exchange arthroplasty, and the rate of cemented versus cementless single-stage exchange arthroplasty for chronic periprosthetic hip infections. There remains an ongoing discrepancy in the literature between the infection recurrence rates after a single-stage exchange arthroplasty compared to a two-stage exchange for chronic periprosthetic hip infections. In the lack of large prospective, randomised controlled comparative trials, this comprehensive systematic review and meta-analysis of observational studies was undertaken to investigate the relative efficacy, in terms of recurrence of the infection, in a single- compared to two-stage exchange arthroplasty for chronic periprosthetic hip infection. We aim to further analyse the infection rates after cemented and cementless single-stage exchanges, which have not been previously undertaken

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