DOS Afhandlingsdatabase

NavnJeppe Lange
Afdeling / StedAarhus Universitetshospital
UniversitetAarhus Universitet
  • Hip and knee surgery
Abstract / Summary

Periprosthetic hip joint infection has always been a devastating complication following
implantation of a hip joint replacement. Important perspectives on the treatment and
outcome of this complication continues to be evaluated, but the overall lack of knowledge
is still profound. There is an urgent need for improvement in our knowledge on chronic
periprosthetic hip joint infections.
The overall aim of this thesis was to evaluate perspectives pertaining to treatment and
outcome of chronic periprosthetic hip joint infection.
We performed a systematic review and meta-analysis (I) on the risk of reinfection
following one-stage and two-stage revisions for chronic periprosthetic hip joint infection.
Two-stage revision is by many regarded as the gold standard in treatment of chronic
periprosthetic hip joint infection. We found a slight increased risk of re-infection following
one-stage revision, although not clinical significant interpreted in light of the included
low-quality studies, and overlapping confidence intervals. The study underscores the need
for improvement in reporting and collection of high quality data.
We evaluated if single-source administrative register data could be of use in research on
chronic periprosthetic hip joint infection(II). Due to the low disease prevalence, registers
would be a valuable sources for research data on chronic periprosthetic hip joint infection.
We found an acceptable positive predictive value of the ICD-10 T84.5 discharge diagnosis
code. We believe this code can be of use in future single-source register based studies, but
preferably should be used in combination with alternate data sources to ensure higher
We investigated the outcome of treatment following chronic periprosthetic hip joint
infection in a non-selected population (III). We found a cumulative incidence of reinfection
just below 15% in the follow-up period, regardless of treatment performed. We
also found a high mortality rate, although causality cannot be established in the study. We
also believe our study indicate bias in favor of two-stage revision, when compared to onestage
revision, as in study I, and that this aspect must be taken into consideration, when
comparing different treatment procedures.
There is still much to be learned regarding chronic periprosthetic hip joint infections, and
we believe, this thesis highlights important perspectives of treatment and outcome, to help
initiate forward progression towards improved patient care.