Clinical Orthopaedics and Related Research®

, Volume 469, Issue 12, pp 3477–3485

Treatment of Early Postoperative Infections after THA: A Decision Analysis

  • Hany Bedair
  • Nicholas Ting
  • Kevin J. Bozic
  • Craig J. Della Valle
  • Scott M. Sporer
Clinical Research

DOI: 10.1007/s11999-011-2119-0

Cite this article as:
Bedair, H., Ting, N., Bozic, K.J. et al. Clin Orthop Relat Res (2011) 469: 3477. doi:10.1007/s11999-011-2119-0

Abstract

Background

The treatment for an early postoperative periprosthetic infection after cementless THA that results in the highest quality of life after the control of infection is unknown. Although common treatments include irrigation and débridement with component retention, a one-stage exchange, or a two-stage exchange, it is unclear whether any of these provides a higher quality of life after the control of infection.

Questions/purposes

We projected, through decision-analysis modeling, the possible estimated final health states defined as health-related quality of life based on quality-of-life studies of an early postoperative periprosthetic infection after cementless THA treated by irrigation and débridement, one-stage exchange, or two-stage exchange.

Methods

Publications addressing early postoperative infections after THA were analyzed for the estimated rate of infection control and quality-of-life measures after a specific treatment. Decision analysis was used to model the different treatments and describe which, if any, treatment results in the greatest quality of life after early THA infection.

Results

In the model, a one-stage exchange was the treatment for early THA infection that maximized quality-of-life outcomes if the probability of controlling the infection exceeded 66% with this procedure. If the probability of infection control of a one-stage exchange was less than 66% or that of irrigation and débridement was greater than 60%, then irrigation and débridement appeared to result in the greatest quality-of-life outcome.

Conclusions

A decision analysis using estimates of infection control rate and quality-of-life outcomes after different treatments for an early postoperative infection after THA showed possible outcomes for each treatment.

Level of Evidence

Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Hany Bedair
    • 1
  • Nicholas Ting
    • 2
  • Kevin J. Bozic
    • 3
  • Craig J. Della Valle
    • 2
  • Scott M. Sporer
    • 2
  1. 1.Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA
  3. 3.Department of Orthopaedic Surgery, Philip R. Lee Institute for Health PolicyUniversity of California, San FranciscoSan FranciscoUSA