Debridement and implant retention in acute hematogenous periprosthetic joint infection after knee arthroplasty: a systematic review.

Balato, Giovanni; Ascione, Tiziana; Matteo, Vincenzo de; Lenzi, Marco; Amato, Massimiliano; Giovanni, Roberto de; Festa, Enrico; Mariconda, Massimo

doi:10.52965/001c.33670

Cited by 8 publications

(7 citation statements)

References 33 publications

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“…The presented results suggest that patients with ALI tend to have worse outcomes and a higher risk of systematic complications. This could be because hematogenous PJI has been described to be diagnosed later and to have more virulent pathogens with more resistances [ 46 ]. The above parameters may indicate that patients with ALI have a higher disease burden, which should be considered in the treatment.…”

Section: Discussionmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.

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Section: Discussionmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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“…Hematogenous PJI features a sudden onset of joint infection after the index arthroplasty being asymptomatic but the interval between arthroplasty and its diagnosis varies in clinical studies, from 30 days to 2 years. 3 In many studies, the interval was set for at least 3 months after arthroplasty. 38,46 Hematogenous PJI is associated with the frequency of bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Application of the Mayo Periprosthetic Joint Infection Risk Score for Total Ankle Arthroplasty

et al. 2023

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Background: Assessing patient’s risk of infection is fundamental for prevention of periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA). The Mayo Prosthetic Joint Infection Risk Score (Mayo Score) is based on data from total hip and knee arthroplasty and has not been validated for application for TAA. Methods: A total of 405 consecutive TAA cases were followed for 6 months for PJI. Individual patients’ Mayo Scores were calculated and analyzed with logistic regression and receiver operating characteristic (ROC) for predictability for PJI. A critical cut-off Mayo Score for patients at high risk of PJI was determined by best Youden index. Among the Mayo Score–defined high-risk patients, the contribution of different risk factors were compared between the PJI and non-PJI patients. Results: There were 10 cases of PJI (2.5%) among the 405 cases within 6 months after TAA. Of the 405 patients, the Mayo Scores ranged between −4 and 13 (median 2; interquartile range 0-5). The average Mayo Score was 2.5 ± 3.4 in the non-PJI patients and 7.7 ± 3.1 in the PJI patients ( P < .001). Logistic regression showed that the probability of PJI increased with higher Mayo Scores (odds ratio 1.48, 95% CI 1.23-1.78). All but 1 PJI patients had a Mayo Score >5. The sensitivity and specificity were 90.0% and 84.3%, respectively, when a Mayo Score >5 was used as a criterion for high risk of PJI. Conclusion: This study demonstrated that the Mayo Score could similarly predict PJI risk after TAA as in total hip and knee arthroplasty. Data analysis suggests that a Mayo Score >5 could be a criterion for identifying high-risk patients for PJI, although further validation with a large number of PJI cases is necessary. Level of Evidence: II, developing diagnositic criteria with consecutive cases.

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“…11 Debridement, Antibiotics and Implant Retention (DAIR) is a technique that is increasingly used in the operating room: it includes the removal of all infected and necrotic tissues, the debridement of all prosthetic components, the exchange of the modular components and the extensive irrigation, and the application of local antibiotics through antibiotics loaded bone cement or beads. [12][13][14][15] DAIR is less invasive for the patient and less expensive compared to revision surgery, but its failure rate is still high. 16 Although many studies have been made about the incidence of the type of antibiotics, 17 the timing of the procedure, 18 or the change of the modular components, 19 there are no substantial work for improving the lavage/debridement method.…”

Section: Introductionmentioning

confidence: 99%

“…For acute and early postoperative infections, when the implant is stable and there is sufficient soft tissue, surgeons avoid the implant replacement and choose more conservative solutions, namely retaining the implant 11 . Debridement, Antibiotics and Implant Retention (DAIR) is a technique that is increasingly used in the operating room: it includes the removal of all infected and necrotic tissues, the debridement of all prosthetic components, the exchange of the modular components and the extensive irrigation, and the application of local antibiotics through antibiotics loaded bone cement or beads 12–15 . DAIR is less invasive for the patient and less expensive compared to revision surgery, but its failure rate is still high 16 .…”

Section: Introductionmentioning

confidence: 99%

Piezoelectric ultrasonic debridement as new tool for biofilm removal from orthopedic implants: A study in vitro

Russo

Gatti

Felici

et al. 2023

Journal Orthopaedic Research

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Pulse lavage (PL) debridement is the standard treatment used in Debridement, Antibiotics and Implant Retention (DAIR) for bacterial biofilm removal during acute and early postoperative cases of periprosthetic joint infection (PJI). The failure rate of DAIR is still high due to the inadequacy of PL in removing the biofilm. Ultrasound‐based techniques are a well‐established tool for PJI diagnosis due to their ability to completely eradicate the biofilm from implant surfaces. Hence, this study investigates the efficiency of a piezoelectric ultrasonic scalpel (PUS) in removing bacterial biofilm from different orthopedic implant materials in vitro and compares the results with PL. Biofilms of methicillin‐resistant Staphylococcus aureus strains were grown on titanium alloy (Ti6Al4V ELI), stainless steel (AISI 316L), and ultrahigh molecular weight polyethylene (UHMWPE) disks for 24 h. The disks of each material were divided into three groups: (i) a control group (no lavage/debridement), (ii) a group treated with PL, (iii) a group treated with PUS. The disks were then sonicated for viable cell count to measure the residual biofilm content. Compared to the initial cell count (105 CFU/mL for each material), PL showed a two‐log reduction of CFU/mL (p < 0.001 for each material), while for PUS a four‐log reduction was found (p < 0.001 for each material). The comparison between the two lavage/debridement displayed a two‐log reduction of CFU/mL (p < 0.001 for each material) of PUS compared with PL. Its increased efficiency compared with PL promotes the use of PUS in removing bacterial biofilm from orthopedic implants, suggesting its implementation to improve the success rate of DAIR.

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Debridement and implant retention in acute hematogenous periprosthetic joint infection after knee arthroplasty: a systematic review.

Cited by 8 publications

References 33 publications

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Application of the Mayo Periprosthetic Joint Infection Risk Score for Total Ankle Arthroplasty

Piezoelectric ultrasonic debridement as new tool for biofilm removal from orthopedic implants: A study in vitro

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