Table 1 Characteristics of included studies
Study | No. of subjects | Country | Period of surgery | Participants | Design | Minimal follow-up | Part of component removed | Failure /reinfection definition | Statistical analysis | Outcomes | Age | NOS Scores | PJI definition | Criteria for select | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Single-stage | Two-stage | Single-stage | Two-stage | Â | Â | Single-stage | Two-stage | ||||||||||
Baker 2013 [5] | 33 | 89 | UK | 2008-2010 | Infected TKA | Retrospective cohort | 6 (6-12) M | NA | NA | Yes | Reoperation, knee score, satisfaction | 69.4 ± 10.7 | 70.3 ± 8.9 | 8 | NA | NA | NA |
Bauer 2006 [13] | 30 | 77 | France | NA | Infected TKA | Retrospective cohort | 2 Y | NA | NA | Yes | Reinfection rate, knee score | 71.8 | 68.3 | 8 | Multiple sample germs | NA | NA |
Betsch 2008 [14] | 4 | 51 | Switzerland | 1995-2004 | PJI (Hip and Knee) | Retrospective cohort | 24 M | Infected prosthesis | Yes | Yes | Failure rate | 67.1 ± 11.7 | 9 | Sinus tract, positive cultures, tissue neutrophils, or pus hint infection | NA | NA | |
Castellani 2017 [15] | 35 | 75 | Canada | 2000-2013 | PJI (Hip and Knee) | Retrospective cohort | 12 M | Components | Yes | Yes | Failure rate | 68 | 63 | 9 | Visible infection signs, positive cultures, or pre-op sinus tract | NA | NA |
Chalmers 2020 [16] | 1 | 4 | USA | 2009-2017 | PJI following UKA | Retrospective cohort | 1 (1-9) Y | All components | Yes | Yes | Reinfection, reoperation | 51-87 | 9 | MSIS | NA | NA | |
Choi 2013 [17] | 17 | 44 | USA | 1999-2009 | Infected THA | Retrospective cohort | 12 (12-132) M | All components | Yes | Yes | Reinfection, hip score | NA | NA | 9 | MSIS | Based on patient specifics and surgical conditions | |
Crego 2019 [18] | 20 | 45 | Germany | NA | PJI (Knee) | Retrospective cohort | NA | NA | NA | Yes | Reinfection, hip score | NA | NA | 9 | NA | NA | NA |
Cristea 2007 [19] | 10 | 25 | Romania | 1990-2004 | PJI (Hip and Knee) | Retrospective cohort | NA | NA | NA | Yes | Reinfection | NA | N | 6 | Positive cultures | NA | NA |
Cury 2015 [20] | 6 | 7 | Brazil | 2008-2010 | PJI after TKA | Retrospective cohort | NA | NA | Yes | Yes | Reinfection, life scores | NA | NA | 6 | NA | Good skin condition, no major health issues, and antibiotic-sensitive | Poor skin and tissue conditions |
Engesater 2011 [21] | 501 | 283 | Norway | 1987-2009 | Infected THA | Retrospective cohort | NA | All or partial components | NA | Yes | Reoperation | 71.5 | 71 | 8 | NA | NA | NA |
Gao 2008 [22] | 10 | 5 | China | 1999-2005 | Infected THAs | Retrospective cohort | 12 (12-31) M | All components | NA | Yes | Reinfection, reoperation, hip score | 54-71 | 6 | NA | NA | NA | |
Haddad 2015 [23] | 28 | 74 | UK | 2004-2009 | Chronic infected TKA | Retrospective cohort | 3 (3-9) Y | All components | Yes | Yes | Reinfection, reoperation, knee score | 63 (48-87) | 68 (45-85) | 7 | Same microorganism in 3+ surgical samples from different sites. | (1) minimal bone or soft tissue loss, (2) non-immunosuppressed patients without ongoing sepsis or chronic diseases, (3) isolated low-virulent pre-op organism sensitive to antibiotics. Excluded polymicrobial or multi-resistant infections like MRSA/MRSE. Decision after discussing with microbiologists. | Contraindications present in single-stage |
Hope 1989 [24] | 72 | 19 | UK | 1976-1987 | Coagulase-negative staphylococci infected THA | Retrospective cohort | 2 (2-121) M | All components | NA | Yes | Failure rate | 64 (30-85) | 65 (41-81) | 8 | Diagnosed clinically, hematologically, through imaging, and samples from joint and prosthetic tissues | NA | NA |
Jacquot 2015 [25] | 5 | 14 | France | 1996-2011 | Infected RSA | Retrospective cohort | 12 (12-137) M | NA | NA | Yes | Reinfection, complication rate | 71 (55-83) | 7 | MSIS | By the surgeon, considering the patient’s age and comorbidities, surgical history, infection characteristics, and bone or soft tissue defects. | ||
Kheir 2017 [27] | 11 | 43 | USA | 1991-2014 | Enterococcal PJI (Knee and Hip) | Retrospective cohort | 12 M | NA | Yes | Yes | Failure rate | 66.3 (39-85) | 9 | MSIS | NA | NA | |
Klemt 2021 [9] | 44 | 88 | USA | 2015-2018 | Chronic PJI (Knee) | Retrospective cohort | NA | NA | NA | Yes | Reinfection, reoperation, readmission, patient-reported outcome measures | 64.9 ± 9.2 | 65.4 ± 8.6 | 8 | MSIS | Microorganism with low virulence, patient in good health without immunocompromising systemic conditions, absence of any septic focus, implant loosening, limited soft-tissue defect or condition that impedes direct closure of wound after revision surgery | Major tissue or bone loss, implant looseness, reinfection, resistant/unidentified germs |
Klouche 2012 [28] | 38 | 46 | France | 2002-2006 | PJI (Hip) | Prospective non-randomised study | 24 (24-68) M | All components | Yes | Yes | Reinfection | 63.60 ± 14.8 | 66.87 ± 12.1 | 7 | Positive cultures | Surgeon knew germ pre-exchange, deemed bone loss minor pre-op and during surgery post-component removal | No pre-op microbe diagnosis, major bone loss |
Laffer 2006 [29] | 2 | 13 | Switzerland | 1988-2003 | PJI after TKA | Retrospective cohort | 2 (2-193) M | NA | Yes | Yes | Success rate | 70.1 (43.5–90.1) | 8 | Sinus tract to joint or two of: positive tissue/fluid culture, high neutrophils, high leukocytes, clinical signs, or radiological infection signs | NA | NA | |
Larsson 2018 [30] | 9 | 46 | Switzerland | 2008-2012 | PJI (Hip) | Retrospective cohort | 12 (12-60) M | NA | Yes | Yes | Success rate | 67 (31-90) | 8 | Consensus Meeting on Periprosthetic Joint Infection | NA | NA | |
Lecuire 1999 [31] | 16 | 41 | French | NA | Infected THA | Retrospective cohort | 6.6 Y (mean) | NA | NA | NA | Reinfection, hip score | NA | NA | 6 | NA | NA | NA |
Lemmens 2021 [32] | 1 | 16 | Belgium | 2004-2018 | Infected primary or revision RSA | Retrospective cohort | 24 (24-132) M | NA | Yes | NA | Reinfection, functional outcome | 66.8 (44-81) | 8 | International Consensus Meeting on Orthopedic Infections | Personalized based on bone health, age, overall health, expectations, and compliance, chosen at the surgeon's discretion | ||
Lenguerrand 2022 [7] | 489 | 2377 | International multicenter | 2003-2014 | Infected primary knee arthroplasty | Retrospective cohort | NA | NA | Yes | Yes | Reoperation | 68 ± 10 | 69 ± 9 | 9 | NA | NA | NA |
Leta 2019 [33] | 72 | 243 | Norway | 1994-2016 | PJI after primary TKA | Retrospective cohort | 1 Y | NA | NA | Yes | Reinfection, reoperation, survival rate, mortality rate | 69 ± 9.5 | 69 ± 9.7 | 9 | Based on the assessment of PJI and the clinical picture | NA | NA |
Li 2017 [34] | 22 | 105 | China | 2003-2014 | Infected revision TKA | Retrospective cohort | 12 (12-158) M | Infected prostheses | Yes | Yes | Reinfection, complication | 64.4 ± 9.5 | 9 | MSIS | Confirmed effective antibiotic treatment | Widespread infection symptoms with unclear cultures or resistant organisms or sinus tracts detected beforehand | |
Mahieu 2019 [35] | 15 | 17 | France | 2010-2012 | Streptococcal PJI (Knee and Hip) | Retrospective cohort | 24 M | NA | NA | Yes | Reinfection, reoperation | 77 (69–83) | 7 | IDSA | Based on center expertise, with no bone reconstruction needed, healthy soft tissue, and specific microorganism identification | All other situations | |
Massin 2016 [36] | 108 | 177 | France | 2005-2010 | Infected TKA | Retrospective cohort | 2 Y | NA | NA | Yes | Reinfection, reoperation, knee score, | 71 (63–76) | 67 (59–73) | 8 | Sinus tract to joint or two of: positive tissue/fluid culture, high neutrophils, high leukocytes, clinical signs, or radiological infection signs | NA | NA |
Matar 2021 [8] | 82 | 210 | UK | 2003-2018 | Chronic PJI (Knee) | Retrospective cohort | 2 (2-17.6) Y | NA | Yes | Yes | Success rate, survivorship rate | 71.8 ± 9.8 | 70.5 ± 10.2 | 8 | MSIS | Single organism infection, known sensitivities, healthy immune system, intact soft tissues, and no systemic sepsis or draining sinus indicated suitability | NA |
Ribes 2019 [6] | 21 | 41 | France | 2009-2014 | Chronic infected TKA | Retrospective cohort | 1 Y | NA | Yes | Yes | Reinfection, knee score, | 72.6 ± 9.2 | 69.5 ± 9.1 | 9 | IDSA | Two-stage replacement was preferred when: unknown cause; resistant bacteria to effective antibiotics; skin or fistula issues hindering closure; significant pus risking new prosthesis contamination; substantial bone defects needing grafting. | |
Ritter 2010 [37] | 8 | 68 | Indiana | 1969-2004 | PJI (Knee and Hip) | Retrospective cohort | 1 Y | NA | Yes | Yes | Success rate | 65.4 ± 12.2 | 9 | NA | NA | NA | |
Siddiqi 2019 [38] | 57 | 137 | USA | 2012-2017 | Chronic PJI after primary TKA | Retrospective cohort | 2 Y | NA | Yes | Yes | Reinfection, reimplantation, reoperation rates, success rate | NA | NA | 9 | MSIS | NA | NA |
Sotiriou 2022 [39] | 6 | 42 | Sweden | 2002-2016 | PJI after THA | Retrospective cohort | 2 Y | NA | Yes | Yes | Reinfection, reoperation, operating time, hospital stay, blood loss, hip score | 73 ± 11.8 | 68 ± 10.8 | 9 | History, physical exam, sedimentation rate, C-reactive protein, and bacterial cultures (joint fluid aspiration or biopsy) | NA | NA |
Stone 2017 [40] | 60 | 29 | USA | 2004-2012 | PJI (Shoulder) | Retrospective cohort | 12 (12-105) M | All or partial components | Yes | Yes | Reinfection, reoperation, complication, functional outcome | 69 (30-92) | 65 (27-73) | 9 | Combining previous infection history, physical signs (like skin changes, swelling, draining sinus), lab tests (white cell count, sedimentation rate, C-reactive protein), and positive intraoperative findings (like pus, specific cell count in frozen sections, and cultures). | NA | NA |
Svensson 2019 [41] | 404 | 1250 | Sweden | 1979-2015 | Infected primary THA | Retrospective cohort | 8.6 Y (mean) | All components | NA | Yes | Reinfection, reoperation, survival rate,aseptic loosening | 70 ± 10 | 68 ± 10 | 8 | NA | NA | NA |
Tirumala 2021 [42] | 46 | 92 | USA | 2014-2018 | Chronic PJI (Hip) | Retrospective cohort | 17.8 M (mean) | All components | NA | Yes | Reinfection, reooperation, mortality rate, functional outcome | 68.88 ± 9.47 | 68.17 ± 8.28 | 9 | MSIS and ICM | A mild microorganism infection in a healthy patient without immune system issues, with no visible infection site or implant issues | Severe soft tissue or bone damage, implant looseness, reinfection, resistant or unknown organisms |
Tuecking 2021 [43] | 15 | 48 | Germany | 2013-2019 | Late-onset PJI (Knee) | Retrospective cohort | 18 (18-92) M | NA | Yes | Yes | Reinfection, reoperation, implant survival | 65.0 ± 10.2 | 69.3 ± 11.1 | 9 | EBJIS | NA | NA |
Van den Kieboom 2021 [44] | 30 | 75 | USA | 2010-2018 | Chronic culture-negative PJI (Knee and Hip) | Retrospective cohort | 2.5 (2.5-22.9) Y | NA | Yes | Yes | Reinfection, reoperation, amputation, readmission, mortality, hospital stay | 67.9 ± 10.6 | 65.0 ± 11.0 | 9 | MSIS | NA | NA |
Van Dijk 2022 [45] | 21 | 107 | Netherlands | 2010-2017 | PJI (Knee and Hip) | Retrospective cohort | 4 Y | Infected prosthesis | Yes | Yes | Reinfection, survival rate | 72 (55-92) | 70 (44–92) | 9 | MSIS | Good for infections with effective antibiotics, not for severe systemic infections or when the organism isn't known before surgery or if there's significant soft tissue involvement needing flap coverage | NA |
Wolf 2014 [46] | 37 | 55 | Austria | 1985-2004 | Infected THA | Retrospective cohort | 2 Y | NA | NA | Yes | Reinfection | 67 | 60.4 | 9 | Signs include high white blood cells, increased CRP, redness, swelling, warmth, fluid aspiration, and positive microbiology | NA | NA |
Wouthuyzen-Bakker 2019 [47] | 20 | 78 | International multicenter | 2005-2015 | Late acute PJI (Hip and Knee) | Retrospective cohort | 10 (10-55) M | All components | Yes | Yes | Failure rate | NA | NA | 9 | MSIS | NA | NA |
Xu 2022 [48] | 13 | 36 | China | 2012-2017 | PJI (Hip and Knee) | Retrospective case-control | 2 Y | NA | Yes | Yes | Success rate, complication, remission rate | 63.6 | 9 | NA | NA | NA | |