Study Country Year of study | Patient treatments Number of participants Mean age (% men) | Exclusive surgical method Treatment | Overall follow-up Outcomes Deaths and losses to follow-up | N(%) reinfection at 2 years Details |
---|---|---|---|---|
One-stage | Â | Â | Â | Â |
Buchholz et al., 1981 [19] Germany 1968 to 1977 | Hip arthroplasty for OA (95%), others (5%) N = 640 58.8 years (39.7%) | "Patients with deep infection involving arthroplasties of the hip" (p. 344). Antibiotic-loaded cement | 52 months Need for further exchange, reinfection 90 deaths | 99 (15.5%) Reoperation due to "bad" outcome plus other infection-related outcomes |
Loty et al., 1992 [20] France 1980 to 1988 | THR N = 90 65.7 years (not specified) | "We usually manage infected total hip replacements by a one stage revision" (p. 330). Systemic antibiotics and antibiotic-loaded cement | 47 months ± 29 months Reinfection, other failure, Merle d'Aubigné-Postel score Four deaths, seven lost to follow-up | 8 (8.9%) Infections occurred between 6 and 24 months |
Miley et al., 1982 [21] USA 1969 to 1979 | Hip surgery for fracture dislocation (47%), OA (36%), others (17%) N = 100 (101 hips) Men 56.2 years, women 59 years (53%) | "The operating surgeon must be prepared to perform either of these operations (1-stage or Girdlestone), depending on the surgical findings and medical work-up" (p79). Intensive multiple-drug antimicrobial programme | 48.5 months, minimum 32 months Grading system focusing on quality of life and hip function. Grade IV outcome: drainage, constant pain, further surgery suggested 11 deaths | Eight hips (7.9%) Grade IV outcome No information on reinfection within 2 years |
Raut et al., 1995 [22] Wroblewski, 1986 [24] UK 1979 to 1990 | Cemented primary THR (63%), revision THR (37%) N = 183 64.5 years (48%) | "All infected arthroplasties during this period were treated with 1-stage reimplantation, irrespective of the organism that was cultured, unless the patient had poor quality bone stock." (p. 202. Wroblewski, 1986 [24]) Antibiotic-loaded cement | 93 months, range 24 to 164 months Persistent infection, Merle d'Aubigné-Postel score (pain, function and movement), radiology, re-revision, complications. 14 deaths (0 in year 1) | 6 (3.3%) Reinfection in first 2 years |
Schneider, 1989 [23] Switzerland 1973 to 1988 | Hip implants N = 72 (excluding 13 treated with irrigation alone) Not specified | "Between 1980 and 1988, out of 42 deep infections...." (p. 527) Data also included from 1973 onwards Joint irrigation preceding revision | Follow-up interval not specified. Reinfection (bad outcome) | 19 (26.4%), rate from 1980 (16.1%) No information on reinfection within 2 years |
Two-stage | Â | Â | Â | Â |
Chen et al., 2009 [25] Taiwan 1993 to 2005 | THR (excluding patients with proximal femoral allograft reconstruction) N = 57 51.5 years (72%) | "[A]ccording to the protocol for short-term parenteral antibiotics therapy at this institution...." (p. 189). Interim antibiotic-impregnated cement beads | 67.2 months Reinfection, Harris hip scores, radiological examinations Five deaths and five lost to follow-up | 7 (12.3%) Reinfection in seven patients after first stage described in text |
Fitzgerald and Jones, 1985 [26] USA 1969 to 1979 | Hip implant N = 131 61 years (50%) | "[D]elayed reconstruction in 131 patients who had an infection after a previous total hip arthroplasty...." (p.828. McDonald et al. 1989 [32]). Intensive Cemented reconstruction with no added antibiotic | 49 months; range 2 to 9 years Reinfection | All hip implants 11 (8.4%) Reinfection up to 429 days |
McDonald et al., 1989 [32] 1969 to 1985 | Specifically THR for OA (69%), fracture (13%), other (18%) N = 81 (including additional 13 patients) 60.0 years (53%) | Â | 5.5 years, range 2.0 to 13.6 years Reinfection, complications | THR only 6 (7.4%) estimated from survival curve |
Haddad et al., 2000 [27] UK 1988 to 1992 | THR for OA (72%), other (28%) N = 50 60 years (46%) | "[C]onsecutive patients all of whom were referred with an infected total hip replacement and treated using a standardised protocol" (p. 689). Antibiotic-loaded beads and cement ball Uncemented | 5.8 years, range 2 to 8.7 years Reinfection, Harris hip score, radiological outcome, complications Two deaths | 4 (8%) No information on reinfection within 2 years |
Hsieh et al., 2009 [28] Taiwan 2002 to 2005 | Prosthetic hip N = 99 61 years (61%) | "The use of an ALCS in SEA for PHI has been a routine practice in our institution" (p. 93). Antibiotic-loaded cement spacer | 43 months, range 24 to 60 months Reinfection, Merle d'Aubigné-Postel score (only in comparisons of antibiotic strategies), radiographic results Three deaths, five lost to follow-up | 8 (8.1%) Reinfection between stages |
Romanò et al., 2010 [29] Italy 2000 to 2007 | Hip prostheses N = 102 58 years (34%) | "102 consecutive patients underwent two-stage revision of septic hip replacement" (p. 26). Long-stem or short-stem preformed antibiotic-loaded cement spacers Cementless | 48 months Reinfection, Harris hip score (only in comparisons of antibiotic strategies) Three deaths, nine lost to follow-up | 5 (4.9%) Reinfection within 3 years (including between stages) |
Stockley et al., 2008 [30] UK 1991 to 2004 | THR for OA (60%), posttraumatic arthritis (18%), others (23%) N = 114 64 years (55%) | "[C]onsecutive patients with microbiologically-proven deep chronic infection of the hip were managed by a two-stage exchange procedure" (p.145). Antibiotic-loaded cement beads | 74 months, range 2 to 175 months Reinfection | 9 (7.9%) Reinfection within 1 year |
Toulson et al., 2009 [31] USA 1989 to 2003 | THR N = 132 54.7 years (59%) in patients "who completed the entire protocol" (p.1054) | "All 132 cases of infected THAs treated at our institution...." (p.1052). Spacer containing antibiotic impregnated cement used in 67% | 64.8 months, range 24 to 203 months; eight patients followed for only an average of 7.2 months Reinfection, Harris hip score (mean only) 34 deaths (2 with no infection information), 8 lost to follow-up | 11 (8.3%) Three new infections within 24 months, four infections not eradicated, four patients who died had infections |
Combination of methods | Â | Â | Â | Â |
De Man et al., 2011 [33] Switzerland 1985 to 2004 | THR N = 79 hips 70 years (57%) in patients followed up | One-stage (n = 24), two-stage (n = 55) Some patients had spacers between stages | Mean 3.8 years (SD 2.2) Reinfection, Harris hip score including limping and walking, radiographic outcome Seven lost to follow-up | Overall (n = 2, 2.5%) One-stage (n = 1, 4.5%) Two-stage (n = 1, 2.0%) |
Elson, 1993 [34] UK Not specified | THR N = 296 (definite or possible infection) Not specified | One-stage (n = 235), two-stage (n = 61) Antibiotic-loaded cement pellets used in two-stage method | Not specified Reinfection, mechanical survival, radiological outcome | Overall (n = 36, 12.2%) One-stage (n = 33, 14.0%) Two-stage (n = 3, 4.9%) Time of definite or possible reinfection (mean 25 months, range 1 to 68 months) |
Ketterl et al., 1988 [35] Germany 1976 to 1986 | THR N = 207 69 years (42%) | One-stage (n = 21), two-stage (n = 161), no reimplantation (n = 25) Gentamicin cement | 32 months Reinfection, function | Overall (n = 24, 11.6%) One-stage (n = 7, 33.3%) Two-stage (n = 17, 10.6%) Time of reinfection unclear |
Ladero Morales et al., 1999 [36] Spain 1985 to 1995 | THR N = 62 (another 12 with nonsurgical treatment) 74 years (53%) | One-stage (n = 2), two-stage (n = 37), resection-only (n = 23) Some treated after introduction of perioperative antibiotic protocol | 4.8 years Reinfection, Merle d'Aubigné-Postel score, clinical and functional outcome (pain, mobility, gait) | Overall (n = 3, 4.8%) One-stage (n = 0, 0%) Two-stage (n = 3, 8.1%) Time of reinfection unclear |
Lecuire et al., 1999 [37] France 1982 to 1997 | THR N = 57 70.6 years | One-stage (n = 16), two-stage (n = 41) Uncemented | 6.6 years Reinfection, Merle d'Aubigné-Postel scale, Harris hip score | Overall (n = 2, 3.5%) One-stage (n = 1, 6.3%) Two-stage (n = 1, 2.4%) Time of reinfection unclear |
Oussedik et al., 2010 [38] UK 1999 to 2002 | THR N = 50 65 years (42%) | One-stage (n = 11), two-stage (n = 39) Antibiotic-loaded spacer used in two-stage Gentamicin-loaded cement used in one-stage | 6.8 years, range 5.5 to 8.8 years Reinfection, Harris hip score, VAS satisfaction | Overall (n = 2, 4.0%) One-stage (n = 0, 0%) Two-stage (n = 2, 5.1%) No information on reinfection within 2 years |
Sanzén et al., 1988 [39] Carlsson et al., 1978 [42] Sweden 1974 to 1981 | THR for OA (74%), congenital dislocation (8%), fracture (8%), others (10%) N = 108 (110 hips) 64 years (53%) | One-stage (n = 78 hips), 2-stage (n = 32 hips) In 44% of two-stage procedures, gentamicin-loaded PMMA beads were used Gentamicin-loaded cement | 71 months, range 24 to 117 months Reinfection, loosening, function Eight deaths within 24 months | Overall (n = 22, 20.0%) One-stage (n = 17, 21.8%) Two-stage (n = 8, 25.0%) At least 22 of 25 reinfections in first year |
Vielpeau and Lortat-Jacob, 2002 [40] France Up to December 1998 | THR N = 458 (including acetabular or femoral revision only, excluding methods with retention of components) No age or sex details | One-stage (n = 127), two-stage (n = 222), resection (n = 81) Antibiotic cement (n = 249), no antibiotic cement (n = 100) in one or two stages | Median 3 years, 81.5% followed for minimum of 2 years Reinfection, complications | Overall (n = 72, 15.7%) One-stage (n = 15, 11.8%) Two-stage (n = 33, 14.9%) |