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(Byren)
1) Sample size: 112
2) Framework: Univariate analysis was used to come up with factors for a multivariate model.
3) Message: Patients who develop post-operative infection have more chance of developing
complications, especially in the first 120 days after antibiotic medication is discontinued.
This effect does not have any significant relation with the length of treatment.
4) Implications: On average, patients who develop post-operative Infection tend to take more
time to recover due to increased probability of complications after treatment is withdrawn.
More work is needed to make treatment safer even after antibiotics are discontinued.

(DO)
1) Sample sizes: 20
2) Framework: This study used a two stage exchange with application of antibiotic beads at the
first of 2 debridements
3) Message: There is need for more studies in this area to determine how debridement
techniques and local anti-biotic treatments can effect recovery rates
4) Implications: 90% of the patients fully recovered within a year. More work is needed to make
this a viable solution for patients with weakened immune systems due to post-operative
Infections

(Winkler)
1) Sample sizes: 37
2) Framework: This study uses a 1 stage approach for infected Hip replacement surgeries. There
is no use of cement beads
3) Message: This approach can be very fruitful as it leads to less inconvenience for the patient
receiving the treatment. It is also financially more preferable.
4) Implications: This approach has several key benefits. There is a much lower probability of
complications and deterioration of health. There is also a cost saving advantage for the
healthcare providers. This study does not provide much information on the deifference
between patients with or without complications and has therefore insignificant evidence to
support our PICO.

(Rudelli)
1) Sample size: 32
2) Framework: Single staged protocol
3) Message: This study shows there is a greater advantage to use of 1 stage surgery as compared
to 2 stage surgery as risks involved aren’t drastically different while financial benefits vary
significantly. Since 1 stage surgery requires exposing the patient to the risks of a major
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surgery only once, one may infer that its risk is actually less as compared to the 2 stage
approach. This idea is still debatable.
4) Implications: One stage exchange has very promising results. If pursued further, this
approach would result in a decrease in need for resource allocation as well as a decrease in
the financial costs associated with treatments

(Disch)
1) Sample size: 32
2) Framework: Pelvic surgery spread across 2 stages without exposing patients to local
antibiotic treatments
3) Message: Radical surgical debridement shows promise as recovery rates achieved using this
approach show promise. Having an option of applying local antibiotics can help increase
recovery rates considerably.
4) Implications: In order to determine just how efficient radical debridement can be as a
substitute for local antibody application it is vital that more studies be conducted in this area

(Cabrita)
1) Sample size: 38
2) Framework: 2 stage surgery with application of antibiotic cements and 2 stage surgery
without use of antibiotic cements
3) Message: Treatment which made use of antibiotic cement spacers proved to be more useful
as compared to treatments without antibiotic use. Use of such a treatment can help reduce
time taken for patients with infected prostheses to recover.
4) Implications: Both single and double stage surgeries can be good forms of treating patients.
However, their usefulness depends on the patient they are being used for. Therefore, it should
be up to the doctors to decide which approach to pursue. It would be better to make use of
both these approaches in the future, depending on the case itself.

Common Designs: Most studies used control groups to test their hypotheses. Several studies
made use of both single and double staged treatments although this was not true for all patients.
Use of antibiotic carriers was also a variable of interest in most designs.

Did the findings solve/support your PICO?

Individually it is difficult to decide whether a study supports our PICO. This is because all
studies bring forth their own set of limitations making it difficult to generalize them to our case.
However, collectively we can use all the results acquired to make a case to support our PICO.
There does seem to be a significant difference in the recovery period between patients who
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develop post operative infections as compared to those who do not. This is reflected in their
length of stays, their likelihood of developing infections as well as other complications.
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Works Cited
Byren, I. (2009). One hundred and twelve infected arthroplasties treated with ‘DAIR’
(debridement, antibiotics and implant retention): antibiotic duration and outcome.
Journal of Antimicrobial chemotherapy .
Cabrita, H. B. (2007). Prospective study of the treatment of infected hip arthroplasties with or
without the use of an antibiotic-loaded cement spacer. PubMed.
Disch, A. C. (2006). Two-stage operative strategy without local antibiotic treatment for infected
hip arthroplasty: clinical and radiological outcome. Springer Link .
DO, C. S. (2010). A Two-stage Retention Débridement Protocol for Acute Periprosthetic Joint
Infections. Springer Link .
Rudelli, S. (2008). One-Stage Revision of Infected Total Hip Arthroplasty with Bone Graft. The
journal of arthroplasty
Winkler, H. (2008). One stage uncemented revision of infected total hip replacement using
cancellous allograft bone impregnated with antibiotics. The bone and joint journal .