Objective:

To compare the effectiveness of single-stage and two-stage revision strategies for hip prosthetic joint infections (PJI) using electronic health records from Chinese hospitals.

Approach:

• Study Design: A retrospective cohort study emulating the INFORM trial was conducted using electronic health record data from three tertiary hospitals in China, adhering to established protocols for target trial emulation.
• Data Collection: EHR data were collected for patients undergoing hip PJI revision from January 1, 2018, to June 30, 2022, ensuring a minimum of 18 months of follow-up for each patient.

Key Findings:

• Single-stage revision demonstrated superior functional outcomes at 3 months compared to two-stage revision (mean difference 11.53, P = 0.003).
• Intraoperative adverse events were significantly fewer in the single-stage revision group (8% vs 27%, P = 0.01).
• At 18 months, no significant difference in functional outcomes was observed between the two strategies (mean difference 0.13, P = 0.98).
• Infection outcomes were not significantly different between the two strategies (14% for single-stage vs 11% for two-stage, P = 0.62).

Interpretation:

The findings suggest that while single-stage revision may offer better short-term functional outcomes and fewer intraoperative complications, the long-term functional outcomes and infection rates do not significantly differ between the two strategies. This indicates that the choice of revision strategy may depend on the clinical context and patient-specific factors.

Limitations:

• The retrospective nature of the study may introduce selection bias and limit the ability to establish causality.
• Data were collected from only three tertiary hospitals, which may not be representative of all clinical settings or populations.
• The follow-up period, while a minimum of 18 months, may not capture long-term outcomes beyond this timeframe.
• Potential confounding factors, such as variations in surgical techniques and patient comorbidities, were not fully controlled for in the analysis.

Conclusion:

In summary, single-stage revision strategies for hip PJI may provide advantages in the short term, particularly in terms of functional recovery and reduced complications. However, the lack of significant differences in long-term outcomes suggests that both single-stage and two-stage revisions can be effective options, and the decision should be tailored to individual patient needs and circumstances. Further research is warranted to validate these findings and explore the implications for clinical practice.