Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes

Abstract

DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies. Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance. DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy. Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision. It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon’s responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies. Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008

Surgical Site Infection caused by Non-Hemolytic Staphylococcus aureus Following a Total Knee Arthroplasty at a Class C Hospital in Indonesia

“…The aforementioned patient at the Kertosono Regional Hospital had a late prosthetic joint infection. Several surgical options to treat PJI include debridement, antibiotics, and implant retention (DAIR), as well as single-stage and two-stage revision surgery (Karachalios et al 2014, Karachalios & Komnos 2021. If all of the patient's reconstructive treatments fail, salvage surgeries (e.g., arthroplasty resection, fusion, and above-the-knee amputation) can be undertaken (Gehrke et al 2015).…”

Biofilm on total joint replacement materials can be reduced through electromagnetic induction heating using a portable device

“…Periprosthetic joint infection is among the main complications in orthopaedic surgery, representing the second most frequent indication for replacement surgery in the knee and the fourth in the hip, with an overall incidence of about 2% [1][2][3]. The least aggressive among currently available surgical therapies is debridement with implant retention (DAIR).…”

Infección en prótesis total de rodilla. ¿Cuándo retener los componentes? Una nueva propuesta

“…Es sabido que las infecciones periprotésicas (IPP) son una de las complicaciones más complejas y devastadoras en el campo de la cirugía articular; ésta representa una de las principales causas de revisión de prótesis en el tiempo, 1 es devastadora tanto para el paciente como para el médico tratante. Tiene una incidencia del 1–2% 2 3 y generan un aumento explosivo en los costos de salud, asociado a un impacto severo en la calidad de vida y aumento de la morbi-mortalidad. 4 5…”

“…PPIs represent one of the major causes of prosthesis revision over time, 1 and are devastating for both patients and their doctors. Their incidence ranges from 1– to %2, 2 3 generating an explosive increase in healthcare costs, a severe impact on the quality of life, and increased morbidity and mortality. 4 5…”