Patient-Related Predictors of Treatment Failure after Two-Stage Total Hip Arthroplasty Revision for Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis

Ameya Bhanushali; Liem Tran; Jaiden Nairne-Nagy 4th; Samuel Bereza 3rd; Stuart A Callary; Gerald Atkins; Boopalan Ramasamy; Lucian B Solomon

doi:10.1016/j.arth.2024.04.053

Patient-Related Predictors of Treatment Failure after Two-Stage Total Hip Arthroplasty Revision for Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis

J Arthroplasty. 2024 Apr 25:S0883-5403(24)00376-0. doi: 10.1016/j.arth.2024.04.053. Online ahead of print.

Authors

Ameya Bhanushali¹, Liem Tran², Jaiden Nairne-Nagy 4th³, Samuel Bereza 3rd⁴, Stuart A Callary³, Gerald Atkins³, Boopalan Ramasamy³, Lucian B Solomon³

Affiliations

¹ Royal Adelaide Hospital, Department of Orthopaedics and Trauma, Adelaide, South Australia, Australia; The University of Adelaide, Discipline of Orthopaedics and Trauma, Adelaide, South Australia, Australia. Electronic address: ameya.bhanushali@sa.gov.au.
² Royal Adelaide Hospital, Department of Orthopaedics and Trauma, Adelaide, South Australia, Australia.
³ Royal Adelaide Hospital, Department of Orthopaedics and Trauma, Adelaide, South Australia, Australia; The University of Adelaide, Discipline of Orthopaedics and Trauma, Adelaide, South Australia, Australia.
⁴ The University of Queensland, Faculty of Medicine, Brisbane, Queensland, Australia.

PMID: 38677343
DOI: 10.1016/j.arth.2024.04.053

Abstract

Introduction: Periprosthetic joint infection (PJI) treatment has high failure rates even after two-stage revision. Risk factors for treatment failure after staged revision for PJI are not well defined, nor is it well established how they correlate with the risks of developing an index PJI. Identifying modifiable risk factors may allow preoperative optimization, while identifying non-modifiable risk factors can influence surgical options or advise against further surgery. We performed a systematic review and meta-analysis to better define predictors of treatment failure in two-stage revision for PJI.

Methods: The Pubmed, Embase, and Scopus databases were searched from their inception in December 1976 to April 15, 2023. Studies comparing patient-related variables between patients successfully treated who had two-staged revision total hip arthroplasty and patients with persistent infections were included. Studies were screened, and two independent reviewers extracted data, while a third resolved discrepancies. Meta-analysis was performed on these data. There were 10,052 unique studies screened, and 21 studies met the inclusion criteria for data extraction.

Results: There was good-quality evidence that obesity, liver cirrhosis, and previous failed revisions for PJI are non-modifiable risk factors, while intravenous drug use and smoking are modifiable risk factors for treatment failure after two-stage revision for hip PJI. Reoperation between revision stages was also significantly associated with an increased risk of treatment failure. Interestingly, other risk factors for an index PJI including male gender, American Society of Anaesthesiology score, diabetes mellitus and inflammatory arthropathy did not predict treatment failure. Evidence on Charlson Comorbidity Index was limited.

Discussion: Patients with a smoking history, obesity, intravenous drug use, previous failed revision for PJI, reoperation between stages and LC are more likely to experience TF after two-stage revision THA for PJI. Modifiable risk factors include smoking and IVDU and these patients should be referred to services for cessation as early as possible before two-stage revision THA.