Abstract
Prosthetic joint infection (PJI), although uncommon, is a dreaded and devastating complication of total hip replacement (THR). Whether implant-related factors, such as the fixation method, influences the risk of PJI following THR is contentious. We conducted a systematic review and meta-analysis to evaluate the body of evidence linking fixation methods (cemented, uncemented, hybrid, or reverse hybrid) with the risk of PJI following primary THR. Observational studies and randomised controlled trials (RCTs) comparing fixation methods, and reporting PJI incidence following THR, were identified through MEDLINE, Embase, Web of Science, Cochrane Library, and reference lists of relevant studies up to 24 April 2019. Summary measures were relative risks (RRs) (95% confidence intervals, CIs). We identified 22 eligible articles (based on 11 distinct observational cohort studies comprising 2,260,428 THRs and 4 RCTs comprising 945 THRs). In pooled analyses of observational studies, all cemented fixations (plain and antibiotic combined), plain cemented fixations, hybrid fixations, and reverse hybrid fixations were each associated with an increased overall PJI risk when compared with uncemented fixations: 1.10 (95% CI: 1.04–1.17), 1.50 (95% CI: 1.27–1.77), 1.49 (95% CI: 1.36–1.64), and 1.49 (95% CI: 1.14–1.95), respectively. However, in the first six months, uncemented fixations were associated with increased PJI risk when compared to all cemented fixations. Compared to antibiotic-loaded cemented fixations, plain cemented fixations were associated with an increased PJI risk (1.52; 95% CI: 1.36–1.70). One RCT showed an increased PJI risk comparing plain cemented fixations with antibiotic-loaded cemented fixations. Uncemented and antibiotic-loaded cemented fixations remain options for the prevention of PJI in primary THR.
Highlights
Total hip replacement (THR) is a highly successful and cost-effective orthopaedic intervention for alleviating pain and disability associated with advanced joint disease such as osteoarthritis [1,2]
We aimed to evaluate the body of evidence linking cemented, uncemented, hybrid, and reverse hybrid fixation methods with the risk of Prosthetic joint infection (PJI) following primary THR using a systematic review and meta-analysis of both observational and interventional evidence
Given the uncertainty and controversy regarding the influence of fixation types on the incidence of PJI following THR, we sought to evaluate the body of evidence linking cemented, uncemented, hybrid, and reverse hybrid fixation methods with the risk of PJI following primary THR using a comprehensive systematic review and meta-analysis of observational studies and randomised controlled trials (RCTs)
Summary
Total hip replacement (THR) is a highly successful and cost-effective orthopaedic intervention for alleviating pain and disability associated with advanced joint disease such as osteoarthritis [1,2]. The majority of patients undergoing THR experience marked improvements in pain and function [4], they are not without complications, which include aseptic loosening, dislocation, fracture, adverse reaction to particulate debris, and prosthetic joint infections (PJIs) [3]. PJI is a devastating and dreaded complication of THR [5] and can result in severe pain, functional deficits, poor quality of life, and even death [6]. Increases in obesity, the growing healthcare burden of osteoarthritis, and a predicted rise in the numbers of THRs, the number of patients who will be affected by PJIs will rise proportionately [8]
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