The role of antibiotic calcium sulfate beads in acute periprosthetic knee infection: a retrospective cohort study

Abstract

Background The study aimed to compare debridement, antibiotics, and implant retention (DAIR) vs. debridement antibiotic bead and retention of the implant (DABRI) in terms of infection-free success rate and treatment cost for acute periprosthetic joint infections after total knee arthroplasty (TKA). Method Between 2017 and 2020, 32 patients with acute periprosthetic joint infection who were treated by total knee arthroplasty were retrospectively reviewed. The patients were divided into a DAIR group (n=15) and a DABRI group (n=17). During the DABRI, additional calcium ulphate antibiotic beads were used. Patient age, the Musculoskeletal Infection Society score, microorganisms involved, and success rate were assessed. Results The mean age of DAIR group (n=15) was 69 years, with 7 being male, and 8 female. The mean follow-up period lasted 30 months. The success rate was 80% (12/15). The mean age of DABRI group (n=17) was 64 years, with 10 patients being male and 7 female. The mean follow-up period was 16 months. The success rate was 88% (15/17). There were no significant differences in patient age (P>0.05), the Musculoskeletal Infection Society score (P>0.05), and success rate (P>0.05). A significant difference was found in the follow-up period between the two groups (P<0.05). Conclusion Both DAIR and DABRI could be used to treat acute periprosthetic joint infections and the outcomes and treatment costs of the two procedures were comparable. Additional use of calcium sulfate beads was safe, but might not improve the treatment result. Randomized controlled studies are warranted for the routine use.

Use of Biomaterials in 3D Printing as a Solution to Microbial Infections in Arthroplasty and Osseous Reconstruction

“…The usefulness of these beads as adjuvants had previously been mentioned and can also be corroborated by the findings of Agarwal and Healy [ 408 ]. Joint infections after arthroplasty of the knee are of particular interest as it is in this context that the debridement, antibiotic bead, and retention of the implant (DABRI) method was compared to the debridement, antibiotics, and implant retention (DAIR) method and was found to be similarly effective [ 409 ]. We would also like to note, that, in the context of antibiotic pearls in particular, and of the potential combinations mentioned in this paper in general, the potential of adverse effects, especially associated with drug pairing, is a noteworthy constraint; given that such interactions could affect absorption or toxicity [ 410 , 411 , 412 , 413 ], caution toward administration is deemed necessary [ 414 ].…”

Antibiotic Prophylaxis in One-Stage Revision of Septic Total Knee Arthroplasty: A Scoping Review

“…The treatment involves the removal of the prosthesis, followed by extensivedebridement of nonviable soft tissues, a synovectomy, copious irrigation and lavage, and the reaming of the medullary canals. Once the joint is prepared, cement beads and/or an antibiotic-loaded cement spacer are applied [ 69 ]. Postoperatively, antibiotics are administered according to the sensitivity of the infecting organisms.…”

“…During the second stage, the removal of the microspheres or spacer is performed, and following copious irrigation and washing, further debridement and implantation of the new prosthesis is performed [ 70 ]. According to several authors, the success rate of this type of surgery for a knee replacement infection is between 91.00% and 96.00% [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ].…”

Editorial: Management of PJI/SSI after joint arthroplasty

“…Several studies have investigated the efficacy of different surgical strategies for the treatment of acute PJI after total knee arthroplasty. Natali et al [ 27 ]. compared debridement, antibiotics, and implant retention (DAIR) with debridement, antibiotics, and bead insertion.…”