Does simultaneous bilateral total joint arthroplasty increase deep infection risk compared to staged surgeries? A...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology

Background:

• Previous studies comparing periprosthetic joint infection (PJI) rates between simultaneous bilateral total joint arthroplasty (SBTJA) and staged bilateral total joint arthroplasty (StBTJA) lacked sufficient statistical power.
• Understanding the comparative infection risk is crucial for surgical decision-making in bilateral joint replacement.

Purpose of the Study:

• To conduct a meta-analysis determining if SBTJA increases the deep infection risk compared to StBTJA.
• To provide robust evidence on the safety of simultaneous versus staged bilateral joint replacement procedures.

Main Methods:

• A comprehensive literature search was performed across major databases including PubMed, Embase, Cochrane Library, Web of Science, PEDro, CINAHL, SPORTDiscus, and Scopus.
• A meta-analysis was conducted to pool data from eligible studies, comparing the incidence of PJI between SBTJA and StBTJA patient cohorts.

Main Results:

• The meta-analysis included 16 studies encompassing 36,765 SBTJA patients and 71,558 StBTJA patients.
• The pooled PJI rate was lower for SBTJA (0.84%) compared to StBTJA (1.57%), with an odds ratio (OR) of 0.57 (95% CI: 0.49-0.66).
• Subgroup analyses indicated no significant difference in PJI risk when baseline demographics were similar or when procedures were staged within three months.

Conclusions:

• Simultaneous bilateral total joint arthroplasty (SBTJA) is not associated with an increased risk of periprosthetic joint infection (PJI) compared to staged procedures.
• The findings suggest SBTJA is a safe alternative to StBTJA regarding infection risk.
• Further high-quality research is recommended to solidify these findings and guide clinical practice.