Partial 2-stage exchange for chronic periprosthetic joint infection after total hip arthroplasty: a comprehensive meta-analysis.

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.