Journal article : Review
Contemporary outcomes of debridement, antibiotics and implant retention in knee arthroplasty
- Abstract:
- Periprosthetic joint infection (PJI) is a major complication after knee arthroplasty, with approximately a quarter of knee arthroplasty revisions citing PJI as an indication. With the demand for knee arthroplasty predicted to increase, coupled with a lack of evidence for decreasing PJI risk, an appreciation of the burdens of PJI on both patients and health care systems is vital. Patients with PJI can experience a reduced quality of life as well as increased morbidity, whilst the management of PJI has significant economic implications. Surgical options include debridement, antibiotics and implant retention (DAIR), single-stage revision, two-stage revision and salvage procedures. DAIR involves the systematic debridement of all infected and unhealthy tissues coupled with directed antibiotic therapy, with definitive infection clearance the objective. In contrast to single- and two-stage revision procedures for PJI, DAIR does not involve the removal of fixed implants, with only modular components exchanged. Potential benefits of DAIR include reduced tissue destruction, reduced morbidity and reduced healthcare burdens, but with a higher reinfection risk compared to staged revision techniques, and utility largely restricted to acute bacterial PJI. A review of contemporary DAIR outcomes is of value given advances in the understanding of PJI biology; the development of consensus-based definitions for PJI diagnosis and treatment outcomes; and evolution of DAIR indications and technique. This review discusses outcomes of DAIR for knee PJI, published over the last two decades.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 293.1KB, Terms of use)
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- Publisher copy:
- 10.21037/aoj-20-76
Authors
- Publisher:
- AME Publishing Company
- Journal:
- Annals of Joint More from this journal
- Volume:
- 7
- Article number:
- 9
- Publication date:
- 2022-01-15
- Acceptance date:
- 2020-08-11
- DOI:
- ISSN:
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2415-6809
- Language:
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English
- Keywords:
- Subtype:
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Review
- Pubs id:
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1213535
- Local pid:
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pubs:1213535
- Deposit date:
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2023-06-22
Terms of use
- Copyright holder:
- Middleton et al.
- Copyright date:
- 2022
- Rights statement:
- © Annals of Joint. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license).
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