title: Treatment of early postoperative infections after THA: a decision analysis.
abstract: BACKGROUND
  The treatment for an early postoperative periprosthetic infection after cementless THA that results in the highest quality of life after the control of infection is unknown. Although common treatments include irrigation and débridement with component retention, a one-stage exchange, or a two-stage exchange, it is unclear whether any of these provides a higher quality of life after the control of infection.
  
  
  OBJECTIVE
  We projected, through decision-analysis modeling, the possible estimated final health states defined as health-related quality of life based on quality-of-life studies of an early postoperative periprosthetic infection after cementless THA treated by irrigation and débridement, one-stage exchange, or two-stage exchange.
  
  
  METHODS
  Publications addressing early postoperative infections after THA were analyzed for the estimated rate of infection control and quality-of-life measures after a specific treatment. Decision analysis was used to model the different treatments and describe which, if any, treatment results in the greatest quality of life after early THA infection.
  
  
  RESULTS
  In the model, a one-stage exchange was the treatment for early THA infection that maximized quality-of-life outcomes if the probability of controlling the infection exceeded 66% with this procedure. If the probability of infection control of a one-stage exchange was less than 66% or that of irrigation and débridement was greater than 60%, then irrigation and débridement appeared to result in the greatest quality-of-life outcome.
  
  
  CONCLUSIONS
  A decision analysis using estimates of infection control rate and quality-of-life outcomes after different treatments for an early postoperative infection after THA showed possible outcomes for each treatment.
  
  
  METHODS
  Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. hbedair@gmail.com
authors: Hany
authors: H
authors: Bedair
authors: Nicholas
authors: N
authors: Ting
authors: Kevin J
authors: KJ
authors: Bozic
authors: Craig J
authors: CJ
authors: Della Valle
authors: Scott M
authors: SM
authors: Sporer
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D003646:Debridement; D003661:Decision Support Techniques; D003663:Decision Trees; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery*; D011788:Quality of Life; D007507:Therapeutic Irrigation