Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):3859-3872. doi: 10.1007/s00590-024-04091-6. Epub 2024 Sep 2.
This systematic review aimed to compare outcomes between multiple and single debridement, antibiotics, and implant retention (DAIR) procedures for early periprosthetic joint infection (PJI) in hip and knee arthroplasty.
Four databases were searched from inception till January 2024 for original studies investigating the outcomes of multiple DAIR in hip and knee PJI. The primary outcome was the success rate in eradicating joint infection. This review was conducted per PRISMA guidelines.
A total of 9 observational studies with 1104 participants were included, with a mean age and BMI of 58.37 years (95%CI: 25.77-90.98) and 31.43 kg/m (95%CI: 28.89-34.98), respectively. The mean follow-up period was 58.37 months (95%CI: 25.77-90.98), and the average MINORS score assigned to the review was 17.6 ± 3.46, indicating a low overall risk of bias. An equivalent success rate between single and double DAIR was observed, at 67% (95%CI: 64-71%) and 70% (95%CI: 48-86%), respectively, with no statistically significant difference between the two treatment modalities (p = 0.740). Additionally, the success rate for triple DAIR ranged from 50 to 60%.
This study suggests that double DAIR is a valid treatment option for acute PJI after TKA and THA, with a success rate comparable to single DAIR (70% vs. 67%, p = 0.740). Triple DAIR achieved success rates ranging from 50 to 60%. However, caution is warranted when interpreting these results due to heterogeneity in host comorbidity factors, DAIR protocols, and antibiotic regimens.
Therapeutic, Level III.
本系统评价旨在比较髋关节和膝关节置换术后早期人工关节周围感染（PJI）的多次清创术、抗生素和保留植入物（DAIR）与单次清创术、抗生素和保留植入物（DAIR）的疗效。
从数据库建立到 2024 年 1 月，检索了 4 个数据库，以调查髋关节和膝关节 PJI 中多次 DAIR 的疗效。主要结局是消除关节感染的成功率。本研究按照 PRISMA 指南进行。
共纳入 9 项观察性研究，1104 例患者，平均年龄和 BMI 分别为 58.37 岁（95%CI：25.77-90.98）和 31.43kg/m（95%CI：28.89-34.98），平均随访时间为 58.37 个月（95%CI：25.77-90.98），纳入文献的 MINORS 评分平均为 17.6±3.46，总体偏倚风险较低。单次和双次 DAIR 的成功率相当，分别为 67%（95%CI：64-71%）和 70%（95%CI：48-86%），两种治疗方法之间无统计学差异（p=0.740）。此外，三次 DAIR 的成功率为 50%至 60%。
本研究表明，对于 TKA 和 THA 后急性 PJI，双次 DAIR 是一种有效的治疗选择，成功率与单次 DAIR 相当（70% vs. 67%，p=0.740）。三次 DAIR 的成功率为 50%至 60%。然而，由于宿主合并症因素、DAIR 方案和抗生素方案的异质性，在解释这些结果时需要谨慎。
治疗性，III 级。
