Clinical Scorecard: Effectiveness Comparison of Single-Stage and Two-Stage Revision Strategies for Hip Prosthetic Joint Infections: Insights from an INFORM Target Trial Emulation Utilizing Electronic Health Records

At a Glance

Key Highlights

• Single-stage revision showed superior function at 3 months compared to two-stage revision.

• Intraoperative adverse events were lower in single-stage revision (8% vs 27%).

• At 18 months, no significant difference in infection markers between single-stage (14%) and two-stage (11%) revisions.

Guideline-Based Recommendations

Diagnosis

• Confirm hip PJI prior to revision surgery.

Management

• Consider both single-stage and two-stage revision strategies based on patient context.

Monitoring & Follow-up

• Assess functional outcomes and infection markers at 3 and 18 months post-revision.

Risks

• Be aware of potential for increased intraoperative adverse events with two-stage revision.

Patient & Prescribing Data

Predominantly White European patients undergoing THA for osteoarthritis in the INFORM trial; younger, mainly male patients in China.

Microbiological characteristics and indications for THA differ between populations, which may affect treatment outcomes.

Clinical Best Practices

• Utilize electronic health records for retrospective cohort studies.

• Follow ethical guidelines and obtain necessary approvals for observational studies.

Related Resources & Content

1. BMJ, 2022 -- Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial

2. Clinical Infectious Diseases, 2023 -- Executive Summary: Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America

3. Springer, 2022 -- Assessing the Risk of Failure in Two-Stage Revision for Periprosthetic Joint Infection Following Cemented Total Hip Arthroplasty

4. Springer, 2021 -- Success Rates of Repeat Two-Stage Exchange Arthroplasty for Recurrent Periprosthetic Infections in Hip and Knee Joints

5. Springer, 2024 -- Results of a Cemented Modular Rotational-Hinge Implant Used in Two-Stage Revision for Chronic Periprosthetic Joint Infection of the Knee

6. Infection — The Role of Antibiotic-Infused Cement Spacers in Reducing Reinfection Risk Following Septic Two-Stage Hip Revision Surgery

7. Executive Summary: Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of Americaa | Clinical Infectious Diseases | Oxford Academic

8. Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial | The BMJ

9. Comparative reinfection rate of one-stage versus two-stage revision in the management of periprosthetic joint infection following total hip arthroplasty: a meta-analysis - PMC