Debridement, antibiotics and implant retention in management of infected total knee arthroplasty: A systematic review

Horriat, Saman; Ayyad, Salamah; Thakrar, RR; Fs, Haddad

doi:10.1053/j.sart.2019.01.012

Cited by 6 publications

(8 citation statements)

References 52 publications

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“…30 The current authors established the described stringent timing criteria for DAPRI according to the current literature on biofilm biology and the results of other implant preservation techniques. 26,28,29,[31][32][33][34] The Center for Disease Control (CDC) recently identified a small group of bacteria that are posing a huge threat to global health: these are grouped under the acronym ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter sp.) 35 Unfortunately, >80% of human bacterial infections involve biofilm-producer microorganism and the current literature has shown that biofilm is the main actor in PJI's development.…”

Section: Discussionmentioning

confidence: 99%

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

et al. 2020

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In this article the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining a total hip arthroplasty (THA) undergoing acute periprosthetic joint infection (PJI). This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads. The combination of 3 different surgical techniques (tumour-like synovectomy, Argon Beam application and chlorhexidine gluconate brushing) might enhance the disruption and removal of the bacterial biofilm which is the main responsible of antibiotics and antibodies resistance. The timing of the diagnosis (6 weeks from the original surgery or 1 week from clinical symptoms appearance in the case of an hematogenous infection) and the preoperative isolation of the germ are fundamental in order to obtain a satisfactory outcome. A 12-week course of postoperative antibiotic therapy (6 weeks I.V. and 6 weeks oral) complete the postoperative protocol used by the authors. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous PJI.

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Section: Discussionmentioning

confidence: 99%

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

et al. 2020

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“…12 Classification of PJI assists with decision making when considering DAIR, as acute postoperative and acute haematogenous infections are more likely to be successful than chronic infections. 13…”

Section: Defining Periprosthetic Joint Infectionmentioning

confidence: 99%

“…DAIR is often discouraged in late/chronic PJI due to high rates of failure. 1,[12][13][14] A shorter duration of symptoms has also shown more favourable outcomes following DAIR, with some articles advising DAIR in patients with symptoms less than one week, 4,33 while others say outcomes remain favourable if DAIR is performed within four weeks of symptom onset. 15,37 Despite varying time frames proposed, most authors agree that the sooner DAIR is performed after symptoms have developed, the greater the success rate can be expected to be.…”

Section: Timingmentioning

confidence: 99%

Truth or DAIR? A review of debridement, antibiotics and implant retention

2022

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Debridement, antibiotics and implant retention (DAIR) is a viable treatment option in early postoperative and acute haematogenous periprosthetic joint infections (PJIs) with a stable implant. Despite lower success rates compared to one- and two-stage revisions, DAIR maintains satisfactory outcomes in selected patient groups and, if successful, has similar functional outcomes to primary arthroplasty. DAIR remains an attractive treatment option, providing satisfactory outcomes with decreased healthcare costs, reduced surgical burden on the patient and shorter hospital stays. With success rates of 37-90%, various factors need to be considered when deciding on DAIR as the appropriate treatment option for PJI. The risk of DAIR failure needs to be weighed against the potential benefits of DAIR success. Factors that increase success rates include an open DAIR procedure performed for a low-virulence, antibiotic-sensitive organism, within a short duration between symptom onset and/or index surgery and DAIR. The procedure involves intraoperative exchange of mobile components and copious wound irrigation, followed by an appropriate antibiotic regimen for a minimum of six weeks that can be administered either intravenously or orally in a well-optimised host, without significant soft tissue defects or contraindications to surgery. Factors increasing the risk for DAIR failure include chronic/late PJIs with resistant organisms, especially methicillin-resistant Staphylococcus aureus (MRSA) in poor hosts with significant comorbidities, such as chronic obstructive pulmonary disease (COPD), liver cirrhosis, rheumatoid arthritis, advanced age > 80 years, patients with fracture indications for arthroplasty and those who cannot tolerate rifampicin- and fluoroquinolone-based antibiotic regimens. Unfortunately, there is no definitive factor to serve as an indication of whether DAIR will be successful, but with recent data showing that a failed DAIR procedure does not lower success in future staged revisions, then even in the face of a 50% success rate, DAIR can maintain its role as an initial treatment option in the management of PJIs

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“…The recent literature from the International Consensus Meeting on Periprosthetic Joint Infections (ICM 2018) [ 5 ] has confirmed that many contemporary conservative measures failed to eradicate the biofilm from the periprosthetic environment. A recent metanalysis from Horriat and et al [ 26 ] showed that, following the appropriate preoperative indications, Debridement, Antibiotic, Implant Retention (DAIR) has an average success rate of 66%. Calanna et.…”

Section: Periprosthetic Joint Infection (Pji) Treatmentmentioning

confidence: 99%

Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

et al. 2021

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Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.

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Debridement, antibiotics and implant retention in management of infected total knee arthroplasty: A systematic review

Cited by 6 publications

References 52 publications

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

Truth or DAIR? A review of debridement, antibiotics and implant retention

Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

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