scholarly journals Implant Fixation and Risk of Prosthetic Joint Infection Following Primary Total Hip Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies

2019 ◽  
Vol 8 (5) ◽  
pp. 722 ◽  
Author(s):  
Setor K. Kunutsor ◽  
Andrew D. Beswick ◽  
Michael R. Whitehouse ◽  
Ashley W. Blom ◽  
Erik Lenguerrand
Keyword(s):  
Total Hip Replacement ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Observational Studies ◽  
Meta Analysis ◽  
Joint Infection ◽  
Fixation Methods ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Observational Cohort

Prosthetic joint infection (PJI), although uncommon, is a dreaded and devastating complication of total hip replacement (THR). Whether implant-related factors, such as the fixation method, influences the risk of PJI following THR is contentious. We conducted a systematic review and meta-analysis to evaluate the body of evidence linking fixation methods (cemented, uncemented, hybrid, or reverse hybrid) with the risk of PJI following primary THR. Observational studies and randomised controlled trials (RCTs) comparing fixation methods, and reporting PJI incidence following THR, were identified through MEDLINE, Embase, Web of Science, Cochrane Library, and reference lists of relevant studies up to 24 April 2019. Summary measures were relative risks (RRs) (95% confidence intervals, CIs). We identified 22 eligible articles (based on 11 distinct observational cohort studies comprising 2,260,428 THRs and 4 RCTs comprising 945 THRs). In pooled analyses of observational studies, all cemented fixations (plain and antibiotic combined), plain cemented fixations, hybrid fixations, and reverse hybrid fixations were each associated with an increased overall PJI risk when compared with uncemented fixations: 1.10 (95% CI: 1.04–1.17), 1.50 (95% CI: 1.27–1.77), 1.49 (95% CI: 1.36–1.64), and 1.49 (95% CI: 1.14–1.95), respectively. However, in the first six months, uncemented fixations were associated with increased PJI risk when compared to all cemented fixations. Compared to antibiotic-loaded cemented fixations, plain cemented fixations were associated with an increased PJI risk (1.52; 95% CI: 1.36–1.70). One RCT showed an increased PJI risk comparing plain cemented fixations with antibiotic-loaded cemented fixations. Uncemented and antibiotic-loaded cemented fixations remain options for the prevention of PJI in primary THR.

Prosthetic joint infection following total hip replacement

2014 ◽  
Vol 38 (11) ◽  
pp. 2429-2430 ◽  
Author(s):  
Matthias Wolf ◽  
Heimo Clar ◽  
Andreas Leithner ◽  
Patrick Sadoghi
Keyword(s):  
Total Hip Replacement ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Total Hip ◽  
Prosthetic Joint

scholarly journals Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange

2014 ◽  
Vol 38 (7) ◽  
pp. 1363-1368 ◽  
Author(s):  
Matthias Wolf ◽  
Heimo Clar ◽  
Jörg Friesenbichler ◽  
Gerold Schwantzer ◽  
Gerwin Bernhardt ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Stage Versus ◽  
Two Stage ◽  
Total Hip ◽  
One Stage ◽  
Prosthetic Joint

scholarly journals Streptococcus gordonii—a rare cause of prosthetic joint infection in a total hip replacement

2017 ◽  
Vol 2017 (1) ◽  
pp. rjw235 ◽  
Author(s):  
Christopher Fenelon ◽  
John G. Galbraith ◽  
David M. Dalton ◽  
Eric Masterson
Keyword(s):  
Total Hip Replacement ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Streptococcus Gordonii ◽  
Total Hip ◽  
Prosthetic Joint

scholarly journals Influence of Fixation Methods on Prosthetic Joint Infection Following Primary Total Knee Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies

2019 ◽  
Vol 8 (6) ◽  
pp. 828 ◽  
Author(s):  
Setor K. Kunutsor ◽  
Vikki Wylde ◽  
Michael R. Whitehouse ◽  
Andrew D. Beswick ◽  
Erik Lenguerrand ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Prosthetic Joint Infection ◽  
Observational Studies ◽  
Meta Analysis ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
Observational Cohort ◽  
Total Knee ◽  
Uncemented Fixation ◽  
Primary Total Knee

The type of fixation used in primary total knee replacement (TKR) may influence the risk of prosthetic joint infection (PJI). We conducted a systematic review and meta-analysis to assess published evidence linking type of fixation (cemented, uncemented, or hybrid) with the risk of PJI following primary TKR. Randomised controlled trials (RCTs) and observational cohort studies comparing fixation methods and reporting PJI incidence following primary TKR were identified in MEDLINE, Embase, Web of Science, and Cochrane Library up until November 2018. Summary measures were relative risks (RR) with 95% confidence intervals (CIs). We identified 32 eligible articles (24 observational studies and 8 RCTs) involving 1,161,292 TKRs. In pooled analysis of observational studies, uncemented fixation was associated with a decreased overall PJI risk when compared with cemented fixation at 0.76 (0.64–0.89). Comparing antibiotic-loaded cemented fixation with plain cement, there was no significant difference in overall PJI risk at 0.95 (0.69–1.31), but PJI risk was increased in the first 6-month postoperative period to 1.65 (1.12–2.43). Limited data from RCTs showed no differences in PJI risk among the fixation types. Observational evidence suggests uncemented fixation may be associated with lower PJI risk in primary TKR when compared with cemented fixation. In the early postoperative period, antibiotic-loaded cemented fixation may be associated with increased PJI risk when compared with plain cement. This may either reflect appropriate selection of higher risk patients for the development of PJI to cemented and antibiotic-loaded cement or may reflect a lower PJI risk in uncemented TKR due to factors such as shorter operative time.

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