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Published on: December 3, 2017
Partial 2-stage exchange for chronic periprosthetic joint infection after total hip arthroplasty: a comprehensive
José María Lamo-Espinosa1, Gonzalo Mariscal2, Francisco Soler3
1Department of Orthopaedic Surgery, IMED Colón, Valencia, Spain.
Insights
Partial 2-stage exchange (PTCR) offers an 88% infection eradication rate for chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA). This approach may preserve bone stock and improve function, though further research is needed for resistant strains.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Technology
Background:
- Periprosthetic joint infection (PJI) is a severe complication of total hip arthroplasty (THA).
- Conventional 2-stage revision (CDCR) is the gold standard but causes significant bone loss and prolonged recovery.
- Partial 2-stage exchange (PTCR) is explored as an alternative for chronic PJI.
Purpose of the Study:
- To systematically review and meta-analyze the clinical efficacy of PTCR for chronic PJI with a stable femoral component.
- To assess infection eradication rates, complications, and functional outcomes associated with PTCR.
Main Methods:
- Systematic review and meta-analysis following the PICOS framework.
- Searched PubMed, Embase, Scopus, and Cochrane Library without time or language restrictions.
- Data extraction and quality assessment using MINORS criteria; statistical analysis performed using R Studio.
Main Results:
- Analyzed 13 studies with 239 patients; PTCR achieved an 88% infection eradication rate (homogenous).
- Reported secondary outcomes: 12% re-operations, 8% mortality, 1% fractures, 13% infectious complications, 3% systemic complications.
- Observed 89% implant stability and functional improvement (mean Harris Hip Score 37.77); 14% treatment failure rate.
Conclusions:
- PTCR demonstrates favorable infection eradication and may reduce bone loss, optimizing functional outcomes in chronic PJI.
- Efficacy against resistant strains and optimal patient selection require further investigation.
- Well-designed comparative studies with longer follow-up are necessary to establish PTCR treatment algorithms.
Background:
Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA) that has major clinical and financial implications. Despite CDCR being the accepted gold standard for chronic PJI, serious complications, such as extensive bone loss and protracted rehabilitation, have led to the investigation of PTCR as an alternative treatment strategy for chronic PJI.
Methods:
According to the PICOS framework, a systematic review and meta-analysis were performed to assess the clinical efficacy of partial 2-stage exchange in chronic PJI with a stable femoral component. There were no time or language limits during the search for relevant articles in PubMed, Embase, Scopus, and Cochrane Library databases. Data extraction and quality assessment were performed according to the MINORS criteria by 2 independent reviewers. Statistical analysis, including heterogeneity and sensitivity analyses, was performed using R Studio software with the appropriate meta-analytical packages.
Results:
13 studies, including 239 patients, were analysed. When the data were pooled, MDCT showed an 88% rate of complete eradication with homogeneity (I² = 0%). Secondary traits included 12% re-operations, 8% deaths, and 1% fractures. Infectious and systemic complications were observed in 13% and 3% of patients, respectively. Implant stability was present in 89% of cases, with significant functional improvement, with a mean Harris Hip Score of 37.77 at the final follow-up. Treatment failure, defined as infection recurrence or the need for chronic antibiotic suppression, was observed in 14% of cases, and sensitivity analysis excluding zero-event studies showed a 17% failure rate.
Conclusions:
Partial 2-stage exchange results in favorable eradication of infection, may reduce bone stock loss, and optimises functional outcomes. However, concerns remain regarding its efficacy against resistant strains and proper patient selection criteria. Well-designed comparative studies with longer follow-up periods are needed to establish treatment algorithms and confirm long-term clinical results.PROSPERO registration number CRD42024599183.
