One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies
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- dc.contributor.author Kunutsor, Setor K.
- dc.contributor.author Sorli Redó, M. Luisa
- dc.contributor.author Beswick, Andrew D.
- dc.contributor.author Beswick, Andrew D.
- dc.contributor.author The Global Infection Orthopaedic Management Collaboration
- dc.date.accessioned 2018-11-07T08:37:13Z
- dc.date.available 2018-11-07T08:37:13Z
- dc.date.issued 2018
- dc.description.abstract One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6-20.7) and 32.3 (95% CI 27.3-38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58-5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.
- dc.format.mimetype application/pdf
- dc.identifier.citation Kunutsor SK, Whitehouse MR, Blom AW, Board T, Kay P, Wroblewski BM. Et al. One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies. Eur J Epidemiol. 2018 Oct;33(10):933-946. DOI: 10.1007/s10654-018-0377-9
- dc.identifier.doi http://dx.doi.org/10.1007/s10654-018-0377-9
- dc.identifier.issn 0393-2990
- dc.identifier.uri http://hdl.handle.net/10230/35713
- dc.language.iso eng
- dc.publisher Springer
- dc.relation.ispartof European Journal of Epidemiology. 2018 Oct;33(10):933-46
- dc.rights Copyright © The Author(s) 2018. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by/4.0/
- dc.subject.keyword Meta-analysis
- dc.subject.keyword One-stage
- dc.subject.keyword Prosthesis related infection
- dc.subject.keyword Re-infection
- dc.subject.keyword Reoperation
- dc.subject.keyword Revision
- dc.subject.keyword Total hip replacement
- dc.subject.keyword Two-stage
- dc.subject.other Articulació coxofemoral -- Cirurgia
- dc.title One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion