University of Washington, Seattle, Washington, USA.
J Bone Joint Surg Am. 2011 Apr 6;93(7):631-9. doi: 10.2106/JBJS.I.01256.
Two-stage revisions of total hip arthroplasties complicated by chronic infection result in reinfection rates that are lower than those following single-stage revisions but may also result in increased surgical morbidity. Using a decision analysis, we compared single-stage and two-stage revisions to determine which treatment modality resulted in greater quality-adjusted life years (QALYs).
A review of the literature on the treatment of patients with an infection at the site of a total hip arthroplasty provided probabilities; utility values for common postoperative health states were determined in a previously published study. With these data, we conducted a Markov cohort simulation decision analysis. Sensitivity analysis validated the model, and comparisons were made in terms of QALYs.
The twelve-month model favored direct-exchange revision over the two-stage approach, regardless of whether surgeon or patient-derived utilities were used (0.945 versus 0.896 and 0.897 versus 0.861 QALYs for the patient and surgeon models, respectively). Similar results were observed in a lifetime model with a ten-year life expectancy (7.853 versus 7.771, and 7.438 versus 7.362 QALYs, respectively). The findings were found to be robust in sensitivity analyses in which clinically relevant ranges of input variables were used.
This analysis favored the direct-exchange arthroplasty over the two-stage approach. This study should be considered hypothesis-generating for future randomized controlled trials in which, ideally, health end points will be considered in addition to the eradication of infection.
全髋关节置换术后慢性感染的两期翻修导致的再感染率低于一期翻修，但也可能导致手术发病率增加。通过决策分析，我们比较了单阶段和两阶段的翻修，以确定哪种治疗方式产生了更多的质量调整生命年（QALYs）。
对全髋关节置换术后感染部位患者的治疗文献进行了回顾，提供了概率；在先前发表的一项研究中，确定了常见术后健康状态的效用值。根据这些数据，我们进行了马尔可夫队列模拟决策分析。敏感性分析验证了模型，并根据 QALYs 进行了比较。
无论使用医生还是患者的效用值，十二个月的模型都倾向于直接交换翻修而不是两期方法（患者和医生模型分别为 0.945 比 0.896 和 0.897 比 0.861 QALYs）。在具有十年预期寿命的终身模型中观察到类似的结果（分别为 7.853 比 7.771 和 7.438 比 7.362 QALYs）。在使用临床相关输入变量范围的敏感性分析中，发现结果具有稳健性。
该分析倾向于直接交换关节置换术而不是两期方法。这项研究应该被认为是未来随机对照试验的假设生成，在这些试验中，除了消除感染外，理想情况下还会考虑健康终点。
