Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
Department of Orthopaedics, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands.
J ISAKOS. 2024 Feb;9(1):62-70. doi: 10.1016/j.jisako.2023.09.003. Epub 2023 Sep 13.
Early periprosthetic joint infection (PJI) represents one of the most fearsome complications of joint replacement. No international consensus has been reached regarding the best approach for early prosthetic knee and hip infections. The aim of this updated systematic review is to assess whether debridement, antibiotics, and implant retention (DAIR) is an effective choice of treatment in early postoperative and acute hematogenous PJI.
This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The diagnostic criteria defining a PJI, the most present pathogen, and the days between the index procedure and the onset of the PJI were extracted from the selected articles. Additionally, the mean follow-up, antibiotic regimen, and success rate of the treatment were also reported.
The articles included provided a cohort of 970 patients. Ten studies specified the joint of their cohort in PJIs regarding either hip prostheses or knee prostheses, resulting in 454 total knees and 460 total hips. The age of the patients ranged from 18 to 92 years old. Success rates for the DAIR treatments in the following cohort ranged from 55.5% up to a maximum of 90% (mean value of 71%).
Even though the DAIR procedure is quite limited, it is still considered an effective option for patients developing an early post-operative or acute hematogenous PJI. However, there is a lack of studies, in particular randomized control trials (RCTs), comparing DAIR with one-stage and two-stage revision protocols in the setting of early PJIs, reflecting the necessity to conduct further high-quality studies to face the burden of early PJI.
早期人工关节感染（PJI）是关节置换术后最可怕的并发症之一。对于早期人工膝关节和髋关节感染的最佳治疗方法，尚未达成国际共识。本系统评价更新的目的是评估清创术、抗生素和保留植入物（DAIR）是否是早期术后和急性血源性 PJI 的有效治疗选择。
本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。从选定的文章中提取出定义 PJI 的诊断标准、最常见的病原体以及指数手术与 PJI 发作之间的天数。此外，还报告了平均随访时间、抗生素方案和治疗成功率。
纳入的文章提供了 970 名患者的队列。有 10 项研究在涉及髋关节假体或膝关节假体的 PJI 中明确了其队列的关节，导致 454 个全膝关节和 460 个全髋关节。患者年龄从 18 岁到 92 岁不等。以下队列中 DAIR 治疗的成功率从 55.5%到最高 90%（平均值为 71%）不等。
尽管 DAIR 手术相当有限，但对于发生早期术后或急性血源性 PJI 的患者，它仍然被认为是一种有效的选择。然而，缺乏研究，特别是比较早期 PJI 中 DAIR 与一期和二期翻修方案的随机对照试验（RCT），反映了需要进行进一步的高质量研究来应对早期 PJI 的负担。
