Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes

Introduction: Septic arthritis of the native hip and knee joint poses particular challenges to orthopedic surgeons. Patients often suffer from several comorbidities, and it could be challenging to find a balance between infection control and adequate function. Two-stage arthroplasty has been addressed as a reli- able solution, however the literature on the topic is composed of case series with small sample size. This systematic review aimed to analyze data on infection control and clinical functional outcomes of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee. Methods: An electronic search of studies published from January 1st, 2000, to June 1st, 2021, was con- ducted using eight different databases. Following the Cochrane Handbook of Systematic Reviews of In- terventions and Preferred Reporting Items for Systematic Revies and Meta-analysis two authors reviewed the available literature and reference lists to identify papers eligible for inclusion. Results: A total of 21 studies were included, involving 435 procedures. The mean age was 57.3 ± 6.2 (45.8 e71.8) years. The mean follow-up was 53.7 ± 18.6 (12e86.7) months. The mean infection eradication was 93.3 ± 6.4%. Mean Harris Hip Score improved from 32.1 ± 10.6 (11.5e42.9) to 87.5 ± 5.7 (80.6e97.8). Mean Knee Society Score improved from 42.9 ± 7.6 (35.9e58.0) to 86.1 ± 5.4 (80.1e96.0). Conclusions: Two-stage arthroplasty for hip and knee septic arthritis provided high infection control rate and excellent function. Further high-quality studies should be oriented on providing a validated algo- rithm for diagnosis and treatment of this condition. Level of evidence: Level IV, systematic review of Level III and IV studies.