Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

Hulleman, Caspar W. J.; de Windt, Tommy S.; Veerman, Karin; Goosen, Jon H. M.; Wagenaar, Frank-Christiaan B. M.; van Hellemondt, Gijs G.

doi:10.3390/jcm12155026

Cited by 5 publications

(3 citation statements)

References 36 publications

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“…In a recent meta-analysis focused on the use of rifampicin, DAIR, achieved a success rate of 69% and 54% in the treatment of THA and TKA staphylococcus aureus infections, respectively. Other studies have reported success rates of 50%–70% in cases of early infections after revision surgeries ( Hulleman et al, 2023 ). Single-stage revision consists in the removal of all the infected components and their replacement with new implants in the same surgical act ( Li et al, 2018 ); whereas in a two-stage revision, the implantation of the new prosthesis is delayed ( Li et al, 2018 ).…”

Section: Discussionmentioning

confidence: 98%

The treatment of bacterial biofilms cultivated on knee arthroplasty implants using the bioelectric effect

Tamimi,

Gasca,

Halbardier

et al. 2024

Front. Bioeng. Biotechnol.

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Introduction: The formation of bacterial biofilms on knee arthroplasty implants can have catastrophic consequences. The aim of this study was to analyze the effectiveness of the bioelectric effect in the elimination of bacterial biofilms on cultivated knee arthroplasty implants.Methods: A novel device was designed to deliver a bioelectric effect on the surface of knee arthroplasty implants. 4-femoral prosthetic implants were cultivated with a staphylococcus aureus inoculum for 15 days. The components were divided into four different groups: A (not treated), B (normal saline 20-minutes), C (bioelectric effect 10-minutes), D (bioelectric effect 20-minutes). The implants were sonicated, and the detached colonies were quantified as the number of colony-forming unit (CFUs). The implants were sterilised and the process was repeated in a standardized manner four more times, to obtain a total of five samples per group.Results: The number of the CFUs after a 10-minute exposure to the bioelectric effect was of 208.2 ± 240.4, compared with 6,041.6 ± 2010.7 CFUs in group A, representing a decrease of 96.5% ± 4.3 (p = 0.004). And a diminution of 91.8% ± 7.9 compared with 2,051.0 ± 1,364.0 CFUs in group B (p = 0.109). The number of bacterial colonies after a 20-minute exposure to the bioelectric effect was 70 ± 126.7 CFUs, representing a decrease of 98.9% ± 1.9 (p = 0.000) compared with group A. And a decrease of 97.8% ± 3.0 (p = 0.019) compared with group B.Conclusions: The bioelectric effect was effective in the elimination of bacterial biofilm from knee arthroplasty implants. This method could be used in the future as part of conventional surgical procedures.

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Section: Discussionmentioning

confidence: 98%

The treatment of bacterial biofilms cultivated on knee arthroplasty implants using the bioelectric effect

Tamimi,

Gasca,

Halbardier

et al. 2024

Front. Bioeng. Biotechnol.

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“…However, the optimal indication, including surgical details such as the irrigation solution, use of local antibiotics and susceptibility of the infectious organism are debated, and may greatly impact success rates [19,26,45]. It is, however, agreed that thorough debridement is one key factor [46].…”

Section: Dairmentioning

confidence: 99%

Surgical Management of Periprosthetic Joint Infections in Hip and Knee Megaprostheses

Theil,

Bockholt,

Gosheger

et al. 2024

Medicina

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Periprosthetic joint infection is a feared complication after the megaprosthetic reconstruction of oncologic and non-oncologic bone defects of including the knee or hip joint. Due to the relative rarity of these procedures, however, optimal management is debatable. Considering the expanding use of megaprostheses in revision arthroplasty and the high revision burden in orthopedic oncology, the risk of PJI is likely to increase over the coming years. In this non-systematic review article, we present and discuss current management options and the associated results focusing on studies from the last 15 years and studies from dedicated centers or study groups. The indication, surgical details and results in controlling infection are presented for debridement, antibiotics, irrigation and retention (DAIR) procedure with an exchange of the modular components, single-stage implant exchange, two-stage exchanges and ablative procedures.

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“…It is now widely known that PJI consists of four different categories divided by postoperative onset time. Two out of the four are the most common types of PJI, which were classified and described by Tsukayama et al: type IIb, early deep postoperative infection (which develops within 4 weeks after surgery), and type III, acute haematogenous infection [7,23,25]. Recognizing and categorizing PJIs according to their type is crucial for tailoring effective and targeted treatment plans that address the specific characteristics and challenges associated with each infection category.…”

Section: Indications and Contraindications: Dapri And Dairmentioning

confidence: 99%

Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Knee Joint Infections: A Literature Review

Vicenti,

Pesare,

Colasuonno

et al. 2024

Healthcare

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(1) Background: Periprosthetic joint infections (PJIs) are severe and frightening complications in orthopaedic surgery, and they are generally divided into three categories: early infections (those occurring within the first 4–6 weeks), delayed infections (those occurring between 3 and 24 months), and late infections (those occurring more than 2 years after surgery). PJI treatment comprises “debridement, antibiotics, and implant retention” (DAIR), single-stage revision, and double-stage revision. Nowadays, to improve the chances of retaining an infected implant and to improve the traditional DAIR method, a modified surgical technique has been developed, named DAPRI (debridement, antibiotic pearls, and retention of the implant). Our study aims to present an up-to-date concept evaluation of the DAPRI technique and its success rate. (2) Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed, applying a protocol defined by the authors: a total of 765 articles were identified, and at the end of the screening process only 7 studies were included. (3) Results: Currently, the DAPRI procedure can be performed only on patients who have had PJI symptoms for less than 4 weeks, and in order to achieve the highest success rate, indications are quite strict: it is appropriate in patients with acute, superficial infections without sinus tract presence, and well-fixed implants with known sensitive bacteria. The DAPRI surgical method follows a step-by-step process consisting of a first phase of biofilm identification with intra-articular injection of methylene blue, followed by biofilm removal (thermic, mechanical, and chemical aggression), and a last step consisting of prevention of PJI recurrence by using calcium sulphate antibiotic-added beads. (4) Conclusions: The DAPRI approach improves the traditional DAIR technique. It is a correct treatment for acute and early haematogenous PJI, and improves the DAIR success rate.

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Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

Cited by 5 publications

References 36 publications

The treatment of bacterial biofilms cultivated on knee arthroplasty implants using the bioelectric effect

The treatment of bacterial biofilms cultivated on knee arthroplasty implants using the bioelectric effect

Surgical Management of Periprosthetic Joint Infections in Hip and Knee Megaprostheses

Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Knee Joint Infections: A Literature Review

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