title: Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review.
abstract: BACKGROUND
  The best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies. The aim of this systematic review is to compare the infection recurrence rate after a single-stage versus a two-stage exchange arthroplasty, and the rate of cemented versus cementless single-stage exchange arthroplasty for chronic periprosthetic hip infections.
  
  
  METHODS
  We searched for eligible studies published up to December 2015. Full text or abstract in English were reviewed. We included studies reporting the infection recurrence rate as the outcome of interest following single- or two-stage exchange arthroplasty, or both, with a minimum follow-up of 12 months. Two reviewers independently abstracted data and appraised quality assessment.
  
  
  RESULTS
  After study selection, 90 observational studies were included. The majority of studies were focused on a two-stage hip exchange arthroplasty (65 %), 18 % on a single-stage exchange, and only a 17 % were comparative studies. There was no statistically significant difference between a single-stage versus a two-stage exchange in terms of recurrence of infection in controlled studies (pooled odds ratio of 1.37 [95 % CI = 0.68-2.74, I2= 45.5 %]). Similarly, the recurrence infection rate in cementless versus cemented single-stage hip exchanges failed to demonstrate a significant difference, due to the substantial heterogeneity among the studies.
  
  
  CONCLUSIONS
  Despite the methodological limitations and the heterogeneity between single cohorts studies, if we considered only the available controlled studies no superiority was demonstrated between a single- and two-stage exchange at a minimum of 12 months follow-up. The overalapping of confidence intervals related to single-stage cementless and cemented hip exchanges, showed no superiority of either technique.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK. davidgeorge@doctors.org.uk.
authors.forename: D A
authors.initials: DA
authors.lastname: George
authors.affiliation: Centre for Reconstructive Surgery and Osteoarticular Infections, Orthopaedic Research Institute Galeazzi, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Logoluso
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.|IRCCS Galeazzi Orthopaedic Institute, Unit of Clinical Epidemiology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Castellini
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Unit of Clinical Epidemiology, Milan, Italy.|Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gianola
authors.affiliation: Centre for Reconstructive Surgery and Osteoarticular Infections, Orthopaedic Research Institute Galeazzi, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Scarponi
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK.
authors.forename: F S
authors.initials: FS
authors.lastname: Haddad
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Unit of Clinical Epidemiology, Milan, Italy.|Clinical Chemistry and Microbiology Lab, IRCCS Galeazzi Institute, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Drago
authors.affiliation: Centre for Reconstructive Surgery and Osteoarticular Infections, Orthopaedic Research Institute Galeazzi, Milan, Italy.
authors.forename: C L
authors.initials: CL
authors.lastname: Romano
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D002908:Chronic Disease; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Cemented; Cementless; Exchange arthroplasty; Infection; Periprosthetic hip infections; Single-stage; Two-stage