One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies
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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DOI：
10.1007/s10654-018-0377-9
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发表时间：
2018-10-01
影响因子：
13.6
通讯作者：
Beswick, Andrew D.
中科院分区：
文献类型：
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作者：
Kunutsor, Setor K.;Whitehouse, Michael R.;Beswick, Andrew D.
一期和二期翻修策略是治疗已确定的髋关节慢性假体周围关节感染（PJI）的两种主要选择;然而，关于哪种是最佳治疗选择还存在不确定性。我们旨在使用汇总的个体参与者数据（IPD）比较两种翻修策略之间的再感染风险。通过检索MEDLINE、EMBASE、Web of Science、科克伦图书馆和WHO国际临床试验注册平台以及与研究者的电子邮件联系，检索了仅通过一期或二期翻修治疗髋关节PJI并报告再感染结局的观察性队列研究。我们分析了来自四大洲44个队列的1856名髋关节PJI参与者的IPD。主要结局是再感染（相同微生物感染复发和/或新微生物再感染）。使用考克斯比例虚弱风险模型计算再感染的风险比（HR）。在平均随访3.7年后，记录了222例再次感染。一期和二期策略的每1000人-年随访的再感染率分别为16.8（95% CI 13.6-20.7）和32.3（95% CI 27.3-38.3）。与一期翻修相比，二期翻修的年龄和性别调整后再感染HR为1.70（0.58-5.00）。在进一步调整潜在混杂因素后，该关联仍然持续缺失。在临床相关亚组中，HR没有显著差异。对汇总的个体患者数据的分析表明，在治疗髋关节PJI方面，一期翻修策略可能与两期翻修策略一样有效。
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.