Debridement, antibiotics and implant retention (DAIR) for the management of knee prosthetic joint infection

Vaz, Kenneth; Scarborough, Matthew; Bottomley, Nicholas; Kendrick, Ben; Taylor, Adrian; Price, Andrew; Alvand, Abtin; Jackson, William F.

doi:10.1016/j.knee.2020.08.011

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…PJI of the knee is a serious but not common complication, and it occurs in 1–2% of the cases, making prospective studies difficult [ 21 ]. Also, the DAIR success rate may depend upon the surgical technique and perioperative management, and these factors may be the reason the surgical results differed between single-center studies [ 5 , 22 ]. Therefore, research related to the success rate of DAIR should be conducted in a multicenter study with relatively larger numbers of subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, research related to the success rate of DAIR should be conducted in a multicenter study with relatively larger numbers of subjects. Although a recent study reported a relatively low DAIR success rate of 64% in patients with early postoperative PJI, other studies reported that it was close to 80% [ 5 , 8 ]. In our study, the overall success rate was 77%.…”

Section: Discussionmentioning

confidence: 99%

“…Periprosthetic joint infections (PJIs) are one of the most serious complications after total knee arthroplasty (TKA) [ 1 – 4 ] ) . In the early stage of a PJI, debridement, antibiotics, and implant retention (DAIR) may be useful surgical options [ 5 , 6 ]. If a PJI can be treated using DAIR, this can substantially reduce the surgical morbidity of the patient [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Chang

Kim

et al. 2022

Knee Surg & Relat Res

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Background We sought to determine (1) the success rate of debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) of the knee in patients with acute postsurgical infection and in those with acute hematogenous infection via a multicenter study, (2) the factors related to the failure of DAIR for overall acute PJI and acute hematogenous PJI via subgroup analysis, and (3) whether the PJI recurrence patterns differed between the two groups over time after DAIR. Methods This retrospective multicenter study included 101 acute knee PJI. Acute postsurgical PJI was defined as PJI diagnosed < 3 months following initial knee arthroplasty surgery. DAIR was performed for 34 cases of acute postsurgical PJIs (postsurgical group) and 67 cases of acute hematogenous PJIs (hematogenous group). The success rates between groups were compared, and factors related to DAIR failure were analyzed. Results The overall success rate of DAIR was 77%. The success rate tended to be higher in the postsurgical group than in the hematogenous group (p = 0.060). However, there was no significant factor related to DAIR failure in the subgroup analysis of acute hematogenous PJIs. In the postsurgical group, the recurrence of PJI occurred until 3 months, whereas in the hematogenous group, recurrence occurred for up to 2 years. Conclusions The failure rate tended to be higher in the acute hematogenous PJI group than in the acute postsurgical PJI group. Since acute hematogenous infections may recur for a longer period than postsurgical infections, careful follow-up is required after DAIR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Chang

Kim

et al. 2022

Knee Surg & Relat Res

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“…Concerning early PJI, DAIR has been proven to be an economical procedure for preserving implants, while a two-stage revision with an antibiotic-loaded interval spacer remains the gold standard protocol for chronic PJI (Romano et al, 2012;Vaz et al, 2020). One of the crucial factors that contribute to infection control is the selection of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Plasma fibrinogen is a reliable marker for diagnosing periprosthetic joint infection and determining the timing of second-stage revision

Xu¹,

Shang²,

Wang³

et al. 2021

International Journal of Infectious Diseases

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We investigated the diagnostic value of fibrinolytic markers for periprosthetic joint infection (PJI), determined their relationship with culture results, and evaluated whether these markers could assess infection control and determine the timing of second-stage reimplantation. Design/methods: This single-center-retrospective study included 206 patients who underwent revision hip or knee arthroplasty (PJI group, n = 79; aseptic loosening [AL] group, n = 127). The plasma levels of fibrinogen, D-dimer, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared, and receiver operating characteristic curves were constructed. Subgroup analysis within the PJI group was also performed. Results: The plasma levels of fibrinogen, D-dimer, ESR, and CRP were significantly lower in the AL group, with an area under the curve of 0.848, 0.669, 0.865, and 0.841, respectively. The plasma level of D-dimer was significantly lower in patients with culture-negative PJI. In patients with residual infection, the levels of all the markers had not significantly changed, while noticeably decreased plasma levels of fibrinogen, ESR, and CRP were detected in patients with successful second-stage reimplantation. Conclusions: Plasma fibrinogen is a promising marker for diagnosing PJI and evaluating persistent infection. Decreased plasma levels of D-dimer in patients with PJI might be linked with negative culture results.

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“…The most widely used prevention method is anchoring the implant in a bed of antibiotic-loaded poly(methyl methacrylate) bone cement (ALBC)[ 4 ]. As for treatment/management, the two common approaches are: (1) Surgical debridement (debridement followed by intravenous or highly bioavailable oral delivery of antimicrobial medication specific to the microorganism found in the case (medical therapy) and retention of the implant (DAIR)[ 14 , 15 ]); and (2) Resection arthroplasty using two-stage exchange[ 16 , 17 ] (although, in recent years, in some countries, enthusiasm is being shown for one-stage exchange[ 18 , 19 ] followed by medical therapy[ 4 , 16 ]). In either option, it is common to fix the exchanged implant to the contiguous bone in an ALBC bed[ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review

Lewis¹

2022

WJO

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Prosthetic joint infection (PJI) is the most serious complication following total joint arthroplasty, this being because it is associated with, among other things, high morbidity and low quality of life, is difficult to prevent, and is very challenging to treat/manage. The many shortcomings of antibiotic-loaded poly (methyl methacrylate) (PMMA) bone cement (ALBC) as an agent for preventing and treating/managing PJI are well-known. One is that microorganisms responsible for most PJI cases, such as methicillin-resistant S. aureus , have developed or are developing resistance to gentamicin sulfate, which is the antibiotic in the vast majority of approved ALBC brands. This has led to many research efforts to develop cements that do not contain gentamicin (or, for that matter, any antibiotic) but demonstrate excellent antimicrobial efficacy. There is a sizeable body of literature on these so-called “antibiotic-free antimicrobial” PMMA bone cements (AFAMBCs). The present work is a comprehensive and critical review of this body. In addition to summaries of key trends in results of characterization studies of AFAMBCs, the attractive features and shortcomings of the literature are highlighted. Shortcomings provide motivation for future work, with some ideas being formulation of a new generation of AFAMBCs by, example, adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement, respectively.

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Debridement, antibiotics and implant retention (DAIR) for the management of knee prosthetic joint infection

Cited by 19 publications

References 18 publications

Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Plasma fibrinogen is a reliable marker for diagnosing periprosthetic joint infection and determining the timing of second-stage revision

Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review

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