One stage vs. two stage in hip periprosthetic joint infections

INTRODUCTION: periprosthetic infections of the hip represent a relatively frequent complication, which can lead to implant failure and serious impairment of the patient's mobility and quality of life. The removal of the infected prosthesis is mandatory for the resolution of the infection. Two treatment strategies are recognized to be reliable and safe: "one -stage" and "two-stage." The aim of this systematic review was to clarify which of the two treatments is burdened by the highest rate of re-infection when used in peri-prosthetic hip infections.EVIDENCE AQUISITION: Studies were identified by major electronic database (OVID, PubMed). All studies reporting results after one or two stage revisions in periprosthetic hip joint infections were included in the review. The following data were extracted from the full text of each included study: authors, year of publication, study design (prospective or retrospective), LOE, number of patients, patients' age, surgical approach (one or two stage), pathogen, length of follow-up, re-infection rate after treatment and complications. Descriptive statistics were used to summarize findings across all studies.EVIDENCE SYNTHESIS: Fifty-three studies comprising 4.646 patients were finally included. Patients treated by one -stage revision were 926. The mean rate of infection eradication was 86.41% (95% CI=67% to 100%). Patients treated by two-stage revision were 3433. The mean rate of infection eradication was 91% (95% CI=77% to 100%). The four stud-ies comparing one-and two-stage revision included 99 patients who underwent one-stage method and 188 patients who underwent two-stage revision. In this case, the mean infection eradication rate was 98.75% (95% CI=95% to 100%) for one-stage revision and 96% (95% CI=94% to 98%) for two-stage revision. The most frequently isolated pathogens were S. aureus and S. epidermidis. Aseptic loosening of the components and hip instability were the most common complica-tions for both methods.CONCLUSIONS: One-or two stage hip revision seem to have no different reinfection rates. New studies are needed to confirm the equal effectiveness of both procedures.