The impact of surgical approach in total hip arthroplasty on the organisms profile of periprosthetic joint infections? A systematic review and meta-analysis.

PURPOSE

To investigate the impact of the surgical approach in total hip arthroplasty (THA) on the organism profile associated with periprosthetic joint infections (PJI).

METHODS

This systematic review and meta-analysis rigorously followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Four online databases (Medline, Embase, Web of Science, Scopus) were searched from inception till the 2nd of Sep 2023. The focus was all articles reporting the organism profile of hip periprosthetic joint infections in relation to the utilized surgical approach. Exclusion criteria encompassed studies lacking infecting organism specification by surgical approach, technical studies, review articles, case reports, non-English articles and inaccessible full-text articles. Quality assessment was done utilizing the Methodological Index for Non-Randomized Studies (MINORS) criteria.

RESULTS

A total of 529 microorganism profiles associated with 285 PJIs were analyzed from 11 studies including 44,271 THA patients. The overall rate of PJI in THA noted in the included studies is 0.64%. No significant difference between the direct anterior approach (DAA) and THA other approaches was noted in the incidence of PJI (OR 1.06, 95% CI [0.67, 1.67], p = 0.92). Similarly, no significant difference between the DAA and other THA approaches was noted in the incidence of gram-negative pathogen induced PJI (OR 3.35, 95% CI [0.49, 22.88], p = 0.22).

CONCLUSION

The overall rate of PJI in THA remain low. Utilization of DAA does not increase the risk of PJI compared to other approaches. Further, DAA does not increase the incidence of gram-negative pathogen induced PJI in THA. However, the available evidence on the organism profile based on the surgical approach is limited, and further studies are needed to make robust conclusions.