Table 1
Characteristics and reported risk factors of the included studies.
| Study | Patients (n) | Age (mean, years) | Follow-up (mean) | Infection rate (%, n) | Infection onset (mean time) | Type of infected prosthesis | Survival without infection | Risk factors | Risk factor analysis |
|---|---|---|---|---|---|---|---|---|---|
| Khakzad et al. [10] | 83 | – | 3.9 years | 16.8% (14) | 141.4 months (knees); 64.6 months (hips); 8.2 months (shoulder) | 4 PT, 5 DF, 2 PF, 2 PH, 1 TF | – | Primary tumor (p = 0.110) | T-test and Mann-Whitney test |
| Knee arthroplasty (compared to hips) | |||||||||
| Non-SC knees(compared to SC knees) | |||||||||
| Higher CCI in PJI cases | |||||||||
| Streitburger et al. [13] | 99 | SC: 37 (5–82); Tit: 38 (7–71) | SC: 43 months | 11.1% (11) | SC: median 4 months (0.5–17) | PF | SC: 90% tit, 83% at 5- and 10-year survival | Radiotherapy administration (p = 0.007) | Univariate analysis |
| Tit: 95 months | Tit: median 11 months (2–55 months) | ||||||||
| Berger et al. [11] | 115 | 53.4 (7.1–88.1) | 7.6 years (1.3–13.3) | 32% (35) | – | 7 PF, 12 DF, 8 PT, 3 Pelvic, 4 PH, 1 DH | – | Primary sarcoma (both bone and ST) | Regression analysis |
| Jeys et al. [2] | 1240 | – | 5.8 years (0.25–33.6) | 11% (136) | Median 8.5 months in 96 PJI occurred within the first 2 years | 18 PF (6.7%), 48 DF (10.3%), 57 PT (23.1%), 11 Pelvic (23%), 2 Humeral (1.1%) | 85–90% and approximately 85% at 5-year and 10-year, varied according to implant site | Subsequent surgery | Cox regression analysis |
| Tibial site | |||||||||
| Pelvic site | |||||||||
| Radiation therapy | |||||||||
| Expandable prosthesis | |||||||||
| Myeloma | |||||||||
| Gosheger et al. [23] | 250 | 30.7 (7.4–80) | 45 months (3–140) | 12% (30) | – | 8 PF, 12 DF, 7 PT | – | Extra-articular resection with DF (6.2-fold higher risk compared with intraarticular resection) | Chi-square test |
| Parry et al. [14] | 394 | 32.4 (4–95) | 54.9 months (2–136) | 8.6% (34) | SC: median 7 months (0–22); Non-SC: 10 months (0–58) | SC: 1 PF, 1 DF, 8 PT, 1 other; Non-SC: 2 PF, 9 DF, 10 PT, 1 PH, 1 other | SC: 90.9% and 86.8%; Non-SC: 95.3% and 91.8% at 1-year and 5-year survival | Any adjuvant treatment | Cox regression analysis |
| Proximal tibia site | |||||||||
| Previous surgery | |||||||||
| Medellin et al. [15] | 81 | 43 (12–86) | 10.3 years (0–31.7) | 19% (15) | 50% of PJI at 2.1 months (0–7); 50% of PJI at a mean of 72 months (12–372) | 81 TF | – | Combined proximal tibia arthroplasty | Cox regression analysis |
| Poor range of movement (0° to 45° of flexion) | |||||||||
| Previous surgery | |||||||||
| Hardes et al. [16] | 98 | SC: 19 (11–78) | SC: 17 months (5–120) | SC: 8.9% (5) | SC: median 8 months (3.5–19) | 98 PT (56 SC) | SC: 90% | Wound healing disturbances (p = 0.040) | Univariate analysis |
| Non-SC: 16 (11–69) | Non-SC: 111 months (3–212) | Non-SC: 16.7% (7) | Non-SC: 18 months (1–71) | Tit: 84% at 5-year survival | SC: prior intralesional surgery (p = 0.040) and operating time (p = 0.001) | ||||
| Allison et al. [19] | 329 | 50 (11–90) | 34 months (0.4–251) | 13.1% (43) | – | 10 hip prostheses, 24 DF, 9 PT | – | Radiation alone | Student t-test |
| Chemotherapy alone | |||||||||
| Sarcoma | |||||||||
| Peel et al. [20] | 121 | 38 (14–86) | 34 months (IQR 17, 80) | 14% (17) | Median 541 days (IQR 41, 952) | 13 Femoral replacements, 4 saddle prostheses | – | Increasing BMI | Univariate logistic regression |
| Increasing operation time | |||||||||
| Increasing post-operative blood transfusion requirements | |||||||||
| Admission to ICU | |||||||||
| Post-operative hematoma | |||||||||
| Morii et al. [22] | 82 | 31.1 (5–86) | 52.3 months (9-105) | 17% (14) | 10.9 months (<1–48) in 10 cases within first 12 months | 8 PT, 6 DF | – | Skin necrosis | Cox proportional hazards modeling |
| Surface infection | |||||||||
| Resection of ≥3 heads of quadriceps muscle in DF | |||||||||
| Dhanoa et al. [17] | 105 | 25 (7–89) | 32 months minimum | 12.38% (13) | 9 days to 63 months | 2 DF, 6 PT, 1 DT, 3 Pelvic, 1 DH | – | Proximal tibia site | Logistic regression model |
| Pelvic site | |||||||||
| Pre-operative hospitalization ≥48 hours | |||||||||
| Subsequent surgery | |||||||||
| Co-morbidities | |||||||||
| Transfusion of >2 RBC units | |||||||||
| Funovics et al. [21] | 166 | 49.8 ± 20.1 (5.9–84.3) | 47 ± 67 months (0–365) | 7.2% (12) | 39 ± 60 months (0–167) | 12 PF | 95.9%, 89.2%, 89.2%, and 77.8% at 1, 5, 10 and 20-year survival | Primary tumor | Survival comparison with log-rank test |
| Cemented fixation | |||||||||
| Additional pelvic reconstruction | |||||||||
| Mavrogenis et al. [18] | 1161 | 31.2 (7–80) | 9 years (3–20) | 8.6% (100) | 3.7 years (0.5 months to 19 years) | 10 PF, 61 DF, 27 PT, 1 TF, 1 Extra-articular knee resection | 88% at 10 years and 84% at 20 years | Cemented fixation | Survival comparison with log-rank test |
| Bone metastasis | |||||||||
| Fujiwara et al. [12] | 121 | 42.1 (7–84) | 5.9 years (0.1–19.8; median: 4.2) | 12% (14) | Within 2 years in 6 patients; >2 years in 8 patients | 3 PF, 7 DF, 4 PT | 5-year and 10-year 100% and 100% (TF), 98% and 89% (PF), 90% and 79% (DF), and 95% and 60% (PT) | STT invading bone | Cox proportional hazards, ROC curve |
| Primary tumor | |||||||||
| Previous surgery | |||||||||
| Male gender | |||||||||
| Operating time | |||||||||
| STT | |||||||||
| Radiotherapy |
SC, silver coated implant; Tit, titanium implant; IQR, interquartile ratio; PJI, peri-megaprosthetic joint infection; PT, proximal tibia; DF, distal femur; PF, proximal femur; PH, proximal humerus; TF, total femur; BMI, body mass index; ICU, intensive care unit; RBC, red blood cell; STT, soft tissue tumor; ROC, receiver operation characteristic.
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