Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes

Abstract

Objectives: We aimed to assess infection control rates after DAIR in patients with periprosthetic joint infection (PJI) following joint arthroplasty and evaluate factors associated with infection control using a systematic review and meta-analysis.

Methods: We searched MEDLINE, EMBASE, Web of Science, Cochrane databases and reference lists of relevant studies up to May 2017. Longitudinal studies conducted in patients with PJI treated exclusively by DAIR were eligible. Infection control rates were meta-analysed using random-effect models after arcsine transformation.

Results: We included 93 articles based on 99 unique observational studies with data on 4897 PJIs treated by DAIR. The infection control rate for DAIR ranged from 11.1% to 100% with an overall pooled estimate of 61.4% (95% CI, 57.3-65.4) and a 95% prediction interval of 25.5% to 91.8%. Infection control rates remained generally similar for several relevant characteristics, except for evidence of variation by age, geographical location, type of infection and joint affected, duration of parenteral antibiotic therapy after the DAIR procedure, and period (year) of DAIR procedure.

Conclusions: The DAIR approach remains an option for the treatment of PJI as it is associated with acceptable infection control rates, particularly in acute postoperative infections and infections of the hip and shoulder joints.

Keywords: Debridement, antibiotics and implant retention; Infection control; Periprosthetic joint infection; Systematic review, Meta-analysis; Total joint arthroplasty.