Outcomes and Risk Factors Associated With Failures of Debridement, Antibiotics, and Implant Retention in Patients With Acute Hematogenous Periprosthetic Joint Infection

Abstract Background The relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract. Methods Consecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored. Results One hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038). Conclusions The presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.

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Outcomes and Risk Factors Associated With 2-Stage Reimplantation Requiring an Interim Spacer Exchange for Periprosthetic Joint Infection

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.09.012 ◽

2020 ◽

Author(s):

Christian Klemt ◽

Evan J. Smith ◽

Venkatsaiakhil Tirumala ◽

Georges Bounajem ◽

Janna van den Kieboom ◽

...

Keyword(s):

Risk Factors ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Factors Associated

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Early Periprosthetic Joint Infection and Debridement, Antibiotics and Implant Retention in Arthroplasty for Femoral Neck Fracture

Hip International ◽

10.5301/hipint.5000467 ◽

2017 ◽

Vol 27 (4) ◽

pp. 349-353 ◽

Cited By ~ 6

Author(s):

Carl Mellner ◽

Thomas Eisler ◽

Björn Knutsson ◽

Sebastian Mukka

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Consecutive Series ◽

Short Term ◽

Term Outcome ◽

Increased Risk ◽

Implant Retention

Introduction Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population. The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty. Methods A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution. 33 (4.5%) of the hips developed an early (<6 weeks post operatively) PJI and 28 (3.8%) of these patients were treated according to the DAIR-protocol. Regression analyses were performed to assess risk factors for developing a PJI. Results DAIR eradicated the PJI in 82% (23/28) of patients at a median follow-up of 31 (SD 29.8) months of the infected hips. The logistic regression analysis indicated that 2 or more changes of the primary dressing due to wound bleeding was associated with an increased risk for developing PJI (OR 4.9, 95% 1.5 to 16.1, p = 0.01). Conclusions The short-term success-rate of DAIR was unexpectedly favourable in this fragile patient population; the results being on par with that after PJI in osteoarthritis patients. The need for repeated bandage changes postoperatively indicates an increased risk for PJI and should prompt early surgical intervention.

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Bacteriology and risk factors associated with periprosthetic joint infection after primary total knee arthroplasty: retrospective study of 2543 cases

Hong Kong Medical Journal ◽

10.12809/hkmj176885 ◽

2018 ◽

Author(s):

KT Siu ◽

◽

FY Ng ◽

PK Chan ◽

Henry CH Fu ◽

...

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Retrospective Study ◽

Knee Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Primary Total Knee Arthroplasty ◽

Factors Associated ◽

Total Knee ◽

Primary Total Knee

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Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty

Clinical Infectious Diseases ◽

10.1093/cid/ciz867 ◽

2019 ◽

Vol 71 (3) ◽

pp. 630-636 ◽

Cited By ~ 3

Author(s):

Claudia A M Löwik ◽

Javad Parvizi ◽

Paul C Jutte ◽

Wierd P Zijlstra ◽

Bas A S Knobben ◽

...

Keyword(s):

Treatment Failure ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Viable Option ◽

Time Intervals ◽

Implant Retention ◽

Time Point ◽

Viable Treatment

Abstract Background The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.

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Debridement, Antibiotics and Implant Retention (DAIR) in Periprosthetic Joint Infection (PJI): what predicts success or failure?

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.05.023 ◽

2021 ◽

Author(s):

Rui Xiang Toh ◽

Zhen Ning Yeo ◽

Ming Han Lincoln Liow ◽

Jerry Yongqiang Chen ◽

Seng-Jin Yeo ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Implant Retention

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Deep infection after hip hemiarthroplasty: risk factors for infection and outcome of treatments

Bone & Joint Open ◽

10.1302/2633-1462.211.bjo-2021-0128.r1 ◽

2021 ◽

Vol 2 (11) ◽

pp. 958-965

Author(s):

Simon Craxford ◽

Ben A. Marson ◽

Jessica Nightingale ◽

Adeel Ikram ◽

Yuvraj Agrawal ◽

...

Keyword(s):

Risk Factors ◽

Joint Infection ◽

Binary Logistic Regression ◽

Deep Infection ◽

Success Rates ◽

Implant Retention ◽

Cemented Arthroplasty ◽

Deep Surgical Site Infection ◽

One Year ◽

Excision Arthroplasty

Aims Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited. Methods Patients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed. Multivariable binary logistic regression was performed to identify and adjust for risk factors for SSI, and to identify factors predicting a successful DAIR at one year. Results A total of 3,966 patients were identified. The overall rate of SSI was 1.7% (51 patients (1.3%) with deep SSI, and 18 (0.45%) with superficial SSI). In all, 50 patients underwent revision surgery for infection (43 with DAIR, and seven with excision arthroplasty). After adjustment for other variables, only concurrent urinary tract infection (odds ratio (OR) 2.78, 95% confidence interval (CI) 1.57 to 4.92; p < 0.001) and increasing delay to theatre for treatment of the fracture (OR 1.31 per day, 95% CI 1.12 to 1.52; p < 0.001) were predictors of developing a SSI, while a cemented arthroplasty was protective (OR 0.54, 95% CI 0.31 to 0.96; p = 0.031). In all, nine patients (20.9%) were alive at one year with a functioning hemiarthroplasty following DAIR, 20 (46.5%) required multiple surgical debridements after an initial DAIR, and 18 were converted to an excision arthroplasty due to persistent infection, with six were alive at one year. The culture of any gram-negative organism reduced success rates to 12.5% (no cases were successful with methicillin-resistant Staphylococcus aureus or Pseudomonas infection). Favourable organisms included Citrobacter and Proteus (100% cure rate). The all-cause mortality at one year after deep SSI was 55.87% versus 24.9% without deep infection. Conclusion Deep infection remains a devastating complication regardless of the treatment strategy employed. Success rates of DAIR are poor compared to total hip arthroplasty, and should be reserved for favourable organisms in patients able to tolerate multiple surgical procedures. Cite this article: Bone Jt Open 2021;2(11):958–965.

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Risk Factor Analysis for Above-knee Amputation in Patients With Periprosthetic Joint Infection of the Knee: a Case-control Study

10.21203/rs.3.rs-440521/v1 ◽

2021 ◽

Author(s):

Franziska Eckers ◽

Christoph J. Laux ◽

Sebastian Schaller ◽

Martin Berli ◽

Yvonne Achermann ◽

...

Keyword(s):

Risk Factors ◽

Alcohol Abuse ◽

Periprosthetic Joint Infection ◽

Case Control Study ◽

Joint Infection ◽

Case Control ◽

Individual Risk ◽

Preoperative Anemia ◽

Knee Amputation ◽

Control Study

Abstract Background: Periprosthetic joint infection (PJI) is a severe complication following knee arthroplasty. Therapeutic strategies comprise a combination of surgical and antibiotic treatment modalities and aim to eradicate the infection. Sometimes control of the disease can only be attained by above-knee amputation (AKA). While a vast amount of literature exists illuminating predisposing factors for PJI, risk factors favoring the endpoint AKA in this context are sparsely known. Methods: The purpose of this investigation was to delineate whether patients with PJI of the knee present specific risk factors for AKA. In a retrospective case-control study 11 cases of PJI treated with AKA were juxtaposed to 57 cases treated with limb salvage (LS). The minimum follow-up was two years. Comorbidities, signs and symptoms of the current infection, factors related to previous surgeries and the implant, microbiology, as well as therapy related factors were recorded. Comparative analysis was performed using student’s t-test, chi-square test or Fisher’s exact test. Binary differences were calculated using odds ratio (OR). Reoperation frequency was compared using Mann-Whitney U test. In-depth descriptive analysis of 11 amputees was carried out. Results: A total of 68 cases aged 71±11.2 years were examined, hereof 11 with AKA and 57 with LS. Severe comorbidities (p=0.009), alcohol abuse (p=0.015), and preoperative anemia (p=0.022) were more frequently associated with AKA. Preoperative anemia was found in all 11 amputees (100%) and in 33 of 57 LS patients (58%) with an average preoperative hemoglobin of 99.9±15.1 g/dl compared to 118.2±19.9 g/dl (p=0.011). No other parameters differed significantly. AKA patients underwent a median of eight (range 2-24) reoperations, LS patients a median of five (range 2-15).Conclusion: Factors potentially influencing the outcome of knee PJI are diverse. The indication of AKA in this context remains a rarity and a case-by-case decision. Patient-intrinsic systemic factors such as alcohol abuse, severe comorbidities and preoperative anemia may elevate the individual risk for AKA in the setting of PJI. We recommend that anemia, being a condition well amenable to therapeutic measures, should be given special consideration in management of PJI patients. Trial registration: This study was registered with Kantonale Ethikkommission Zürich, (BASEC-No. 2016-01048).

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Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

10.21203/rs.3.rs-18525/v1 ◽

2020 ◽

Author(s):

Cheng Li ◽

Cristina Ojeda Thies ◽

Chi Xu ◽

Andrej Trampuz

Keyword(s):

Risk Factors ◽

Bibliometric Analysis ◽

Periprosthetic Joint Infection ◽

Clinical Medicine ◽

Meta Analysis ◽

Joint Infection ◽

Relevant Literature ◽

The United States ◽

Steroid Injections ◽

Joint Replacement Surgery

Abstract Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.

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