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

BMC Infectious Diseases

Research Article

C. L. Romano¹  S. Scarponi¹  N. Logoluso¹  G. Castellini²  F. S. Haddad³  D. A. George³  S. Gianola⁴  L. Drago⁵ 

[1] Centre for Reconstructive Surgery and Osteoarticular Infections, Orthopaedic Research Institute Galeazzi, Milan, Italy;Department of Biomedical Sciences for Health, University of Milan, Milan, Italy;IRCCS Galeazzi Orthopaedic Institute, Unit of Clinical Epidemiology, Milan, Italy;Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK;IRCCS Galeazzi Orthopaedic Institute, Unit of Clinical Epidemiology, Milan, Italy;Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy;IRCCS Galeazzi Orthopaedic Institute, Unit of Clinical Epidemiology, Milan, Italy;Clinical Chemistry and Microbiology Lab, IRCCS Galeazzi Institute, Milan, Italy;

关键词: Infection;    Periprosthetic hip infections;    Exchange arthroplasty;    Single-stage;    Two-stage;    Cemented;    Cementless;   

DOI  :  10.1186/s12879-016-1869-4

 received in 2016-06-07, accepted in 2016-09-27,  发布年份 2016

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2016