Abstract
Late chronic infection is a devastating complication after total hip arthroplasty (THA) and is often treated with surgery. The one-stage surgical procedure is believed to be the more advantageous from a patient and cost perspective, but there is no consensus on whether the one- or two-stage procedure is the better option. We analysed the risk for re-revision in infected primary THAs repaired with either the one- or two-stage method. Data was obtained from the Swedish Hip Arthroplasty Register and the study groups were patients who had undergone a one-stage (n = 404) or two-stage (n = 1250) revision due to infection. Risk of re-revision was analysed using Kaplan–Meier analysis with log-rank test and Cox regression analysis. The cumulative survival rate was similar in the two groups at 15 years after surgery (p = 0.1). Adjusting for covariates, the risk for re-revision due to all causes did not differ between patients who were operated on with the one- or two-stage procedure (Hazard Ratio (HR) = 0.9, 95% Confidence Interval (C.I.) = 0.7–1.2, p = 0.5). The risk for re-revision due to infection (HR = 0.7, 95% C.I. = 0.4–1.1, p = 0.2) and aseptic loosening (HR = 1.2, 95% C.I. = 0.8–1.8, p = 0.5) was similar. This study could not determine whether the one-stage method was inferior in cases when the performing surgeons chose to use the one-stage method.
Highlights
The demand for primary total hip arthroplasties (THA) has steadily increased during the last four decades
We evaluated if there was a higher risk of re-revision between the one- and the two-stage methods due to all causes, recurrent infection, or aseptic loosening after the revision of an infected primary THA
Adjusted for the co-variates in a Cox regression model, there was no difference in the risk for re-revision between the oneand two-stage revision surgeries (HR = 0.9, 95% C.I. = 0.7–1.2, p = 0.5)
Summary
The demand for primary total hip arthroplasties (THA) has steadily increased during the last four decades. According to the Swedish Hip Arthroplasty Register (SHAR,) approximately 17,000 primary THAs are performed annually in Sweden. Orthopaedic infections imply great suffering for the affected patient, with high emotional distress and functional disability, and, in a few patients, PJI may lead to a fatal outcome [4,5,6]. Postoperative infections create an economic burden in terms of high healthcare and societal costs [7]. The cost of managing an infected THA is estimated to be 4.8 times higher than the cost of performing a primary THA [8]. With a suggested increase in infection incidence, an ageing population, and increasing demands for THA, PJI is expected to become an even greater problem in the future [9]
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