Outcomes of 1-Stage Versus 2-Stage Revisions After Hip Prosthetic Joint Infection

Abstract

Background: Prosthetic joint infections (PJIs) are significant complications of total joint arthroplasties. The incidence of this dangerous complication is expected to rise, but there is not a unanimous solution. Two-stage surgical revisions are the traditional gold standard of treatment, but recent literature suggests that 1-stage revisions can be equally effective. A comparison of the outcomes of 2-stage revisions vs. 1-stage revisions has not been thoroughly investigated. This systematic review and meta-analysis were designed to compare the outcomes of 2-stage exchanges vs. 1-stage exchanges in the treatments of hip PJI based on comparison studies. Methods: MEDLINE, Embase, and Cochrane were searched for relevant studies that compared the effectiveness and outcomes of 1-stage and 2-stage procedures from January 2000 to May 2023. Keywords relating to hip PJI were used, and comparison studies of 1-stage vs. 2-stage procedures that reported patient characteristics and outcomes including success rates, rates of reinfection, or other outcomes such as functional outcomes (e.g., mean Harris hip scores), infection-free survival, and blood loss were included. Statistical analysis for this study was conducted using Review Manager 5.4 with a standard p-value of ≤ 0.05 for statistical significance. Results: Fifteen articles and 1,017 patients were included in the meta-analysis. One-stage revision procedures (320 patients) were found to have greater success rates (i.e., lower rates of reinfection) than 2-stage revisions (697 patients) (p = 0.04). One-stage revisions (184 patients) had shorter durations of operation and less blood loss than 2-stage revisions (90 patients) (p < 0.05). Conclusion: One-stage revision procedures are associated with lower reinfection rates, blood loss, and durations of operation compared with 2-stage revisions. Level of Evidence: I.