Luo Hua, He Congcong, Zhao Yong, Yang Guangyong, Hong Hainan
Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
Department of Psychology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
EFORT Open Rev. 2023 Sep 1;8(9):672-679. doi: 10.1530/EOR-22-0142.
Septic arthritis (SA) is an intra-articular infection caused by purulent bacteria and the only effective method is surgical intervention. Two-stage arthroplasty is considered the gold standard treatment for SA, but recent studies have found that single-stage arthroplasty can achieve the same efficacy as two-stage arthroplasty. This study aimed to compare the efficacy of single- vs two-stage arthroplasty in the treatment of (acute or quiescent) SA.
The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature on the treatment of SA using single- and two-stage arthroplasty from the date of database inception to November 10, 2022. Data on reinfection rates were expressed as odds ratios and 95% CIs.
Seven retrospective studies with a total of 413 patients were included. Pooled analysis showed no difference in the reinfection rate between single- and two-stage arthroplasty. Subgroup analysis found no difference between the single- and two-stage arthroplasty groups in the incidence of purulent infection of the hip and knee. Cumulative meta-analysis showed gradual stabilization of outcomes.
Based on our meta-analysis of available retrospective studies, we found no significant difference in reinfection rates between single- and two-stage arthroplasty for SA. Further prospective cohort studies are needed to confirm our results, although our meta-analysis provides important insights into the current literature on this topic.
化脓性关节炎（SA）是由化脓性细菌引起的关节内感染，唯一有效的治疗方法是手术干预。两阶段关节置换术被认为是SA的金标准治疗方法，但最近的研究发现，单阶段关节置换术可取得与两阶段关节置换术相同的疗效。本研究旨在比较单阶段与两阶段关节置换术治疗（急性或静止期）SA的疗效。
根据系统评价和Meta分析的首选报告项目指南进行综述。我们检索了PubMed、EMBASE、Medline和Cochrane图书馆数据库，以识别从数据库建立之日至2022年11月10日期间所有关于使用单阶段和两阶段关节置换术治疗SA的文献。再感染率数据以比值比和95%可信区间表示。
纳入7项回顾性研究，共413例患者。汇总分析显示，单阶段和两阶段关节置换术的再感染率无差异。亚组分析发现，单阶段和两阶段关节置换术组在髋部和膝部化脓性感染发生率方面无差异。累积Meta分析显示结果逐渐稳定。
基于我们对现有回顾性研究的Meta分析，我们发现单阶段和两阶段关节置换术治疗SA的再感染率无显著差异。尽管我们的Meta分析为该主题的当前文献提供了重要见解，但仍需要进一步的前瞻性队列研究来证实我们的结果。
