Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment

Calanna, Filippo; Chen, Foster; Risitano, Salvatore; Vorhies, John S.; Franceschini, Massimo; Giori, Nicholas J.; Indelli, Pier Francesco

doi:10.1177/2309499019874413

Cited by 26 publications

(20 citation statements)

References 29 publications

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“…Two patients (5.5%) had a periprosthetic joint infection (PJI). One patient had a subacute PJI at 10 weeks from the original surgery: the microorganism was isolated, and the patient underwent Debridement, Antibiotic Pearls, Retention of the Implant (DAPRI) procedure [ 15 ] and a course of 12 weeks of antibiotic therapy; he was asymptomatic, and he had normal PJI serologic markers at the time of the latest follow-up (23 months). One patient underwent revision involving explantation at 15 months from the original surgery because of chronic PJI: his original surgery was a two-stage revision following a previous PJI.…”

Section: Resultsmentioning

confidence: 99%

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

Spinello

Thiele

Zepeda

et al. 2022

Knee Surg & Relat Res

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Introduction Revision knee arthroplasty presents a number of challenges, including management of bone loss. The goal in managing moderate to large bone defects is fixation that is sufficient enough to allow early weight-bearing. The purpose of this study was to describe the surgical technique and clinical and radiographic outcomes of patients treated with porous tantalum metaphyseal cones in combination with long uncemented diaphyseal-engaging stems to manage tibial bone loss in revision total knee arthroplasty (TKA). Materials and methods Thirty-six aseptic revision TKAs were performed at our institution between 2016 and 2019 by two senior authors. A single trabecular metal tantalum cone combined with a long (100 or 155 mm) press fit, diaphyseal-engaging stem was used in all cases to reconstruct metaphyseal bone defects and to augment tibial fixation. Cemented stems were excluded. The tibiofemoral angle was measured along the tibial and femoral shaft axes on the weight-bearing anteroposterior radiograph at final follow-up (range 15–56 months). All clinical and surgical complications, reoperations, and revisions of any component were recorded. Survivorship free of revision was evaluated at the time of the latest follow-up. Results The mean Knee Society Score (KSS) and Knee Society Function Score (KSS-F) improved significantly from 29.7 points preoperatively (range 11–54 points) to 86 points (range 43–99 points) and from 20.4 points preoperatively (range 0–55 points) to 72.3 points (range 30–90 points) (p < 0.05), respectively. Eleven tibial constructs (30.5%) had incomplete, nonprogressive radiolucent lines (≤ 2 mm). All tibial cones demonstrated osteointegration. One patient underwent a full revision for periprosthetic joint infection, and survivorship free of any component revision was 91.7% at final follow-up. Conclusions Hybrid fixation with uncemented diaphyseal-engaging stems and porous tantalum metaphyseal cones resulted in radiographic lack of osteolysis, good clinical outcomes, and survivorship of 91.7% at a median follow-up of 33 months when considering all-cause revision as the endpoint.

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Section: Resultsmentioning

confidence: 99%

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

Spinello

Thiele

Zepeda

et al. 2022

Knee Surg & Relat Res

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“…Although DAIR procedures are recommended in the acute setting, a debate persists given that DAIR procedures have questionable success rates ranging from 35 % to 90 % (Azzam et al, 2010;Ottesen et al, 2019;Deirmengian et al, 2003). In an attempt to improve eradication rates, new intraoperative techniques have been proposed to improve upon the DAIR procedure (Shaw et al, 2017;Chung et al, 2019;Calanna et al, 2019). Although interval improvements have been made to the traditional DAIR, timing remains a critical factor.…”

Section: Discussionmentioning

confidence: 99%

Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections

Christopher

McQuivey

Deckey

et al. 2021

J. Bone Joint Infect.

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Abstract. Introduction: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP (mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion criteria: patients >18 years old who underwent surgical revision for PJI and had documented ESR and CRP values. Subjects were divided into two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in characterizing the duration of PJI. Results: 147 patients were included in the study (81 acute and 66 chronic). The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in chronic patients (p<0.001). The ESR / CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for ESR / CRP to predict a chronic (>0.96) vs. acute (<0.96) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and the specificity was 0.90 (95 % CI 0.81–0.94). Conclusions: The ESR / CRP ratio may help determine the duration of PJI in uncertain cases. This metric may give arthroplasty surgeons more confidence in defining the duration of the PJI and therefore aid in treatment selection.

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“…In an established infection, bacteria and biofilm are adherent to the underlying implants and tissues, and there may be a role for high-pressure lavage. Many PJI debridement protocols use up to 9 L of pulsatile lavage 60,61 . However, a 2011 randomized investigation comparing high- and low-pressure lavage in PJI demonstrated no difference in reinfections at the 1-year follow-up 62 .…”

Section: Delivery Methods For Antiseptic Irrigation Solutionsmentioning

confidence: 99%

Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty

et al. 2022

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Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment

Cited by 26 publications

References 29 publications

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections

Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty

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