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Table 1 Characteristics of included studies with 50 or more patients

From: What is the evidence base to guide surgical treatment of infected hip prostheses? systematic review of longitudinal studies in unselected patients

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     
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     
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%)
  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     
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%)
  1. ALCS, antibiotic-loaded cement spacer; OA, osteoarthritis; PHI, prosthetic hip infection; PMMA, polymethylmethacrylate; SEA, staged exchange arthroplasty; THA, total hip arthroplasty; THR, total hip replacement; VAS, Visual Analogue Scale.