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. 2021 Oct;2(10):806-812.
doi: 10.1302/2633-1462.210.BJO-2021-0090.R1.

Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection : a systematic review and meta-regression analysis

Maxime Gerritsen  1   2 , Abdullah Khawar  1 , Henk Scheper  2 , Robert van der Wal  1 , Jan Schoones  3 , Mark de Boer  2 , Rob Nelissen  1 , Bart Pijls  1
Affiliations

Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection : a systematic review and meta-regression analysis

Maxime Gerritsen et al. Bone Jt Open. 2021 Oct.

Abstract

Aims: The aim of this meta-analysis is to assess the association between exchange of modular parts in debridement, antibiotics, and implant retention (DAIR) procedure and outcomes for hip and knee periprosthetic joint infection (PJI).

Methods: We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane library from inception until May 2021. Random effects meta-analyses and meta-regression was used to estimate, on a study level, the success rate of DAIR related to component exchange. Risk of bias was appraised using the (AQUILA) checklist.

Results: We included 65 studies comprising 6,630 patients. The pooled overall success after DAIR for PJI was 67% (95% confidence interval (CI) 63% to 70%). This was 70% (95% CI 65% to 75%) for DAIR for hip PJI and 63% (95% CI 58% to 69%) for knee PJI. In studies before 2004 (n = 27), our meta-regression analysis showed a 3.5% increase in success rates for each 10% increase in component exchange in DAIR for hip PJI and a 3.1% increase for each 10% increase in component exchange for knee PJI. When restricted to studies after 2004 (n = 37), this association changed: for DAIR for hip PJI a decrease in successful outcome by 0.5% for each 10% increase in component exchange and for DAIR for knee PJI this was a 0.01% increase in successful outcome for each 10% increase in component exchange.

Conclusion: This systematic review and meta-regression found no benefit of modular component exchange on reduction of PJI failure. This limited effect should be weighed against the risks for the patient and cost on a case-by-case basis. The association between exchange of modular components and outcome changed before and after 2004. This suggests the effect seen after 2004 may reflect a more rigorous, evidence-based, approach to the infected implant compared to the years before. Level of Evidence: Level III Cite this article: Bone Jt Open 2021;2(10):806-812.

Keywords: DAIR; Modular component exchange; Periprosthetic joint infection; Periprosthetic joint infection (PJI); Total joint replacement; debridement; debridement, antibiotics, and implant retention; hips; knee periprosthetic joint infection; knees; lower limb arthroplasties; randomized controlled trials; regression analysis; revision arthroplasties.

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Conflict of interest statement

ICMJE COI statement: B. Pijls reports government funding from ZonMw (09150161810084; 451001003), unrelated to this study. B. Pijls and R. Nelissen are listed as co-inventors on a provisional patent application from the Leiden University Medical Center (WO2020/067898) regarding induction heating of infected prosthetic joint replacements - no payments have been made - and provide unpaid advice to "Implant Preservation Devices (IPD)" as part of a licence agreement of the LUMC with IPD. R. Nelissen reports an institutional grant from VENI/NWO, related to the study, and from NWA/NWO DartBac, unrelated to the study.

Figures

Fig. 1
Fig. 1
Flowchart of literature selection.
Fig. 2
Fig. 2
a) Scatterplot showing the association between exchange of modular components and successful outcome of debridement, antibiotics, and implant retention (DAIR) for hip periprosthetic joint infection (PJI). The results from the meta-regression are presented as a blue line with red 95% confidence interval (CI). Both variables are presented as proportions of all included hips in the study cohort. b) Scatterplot showing the association between exchange of modular components and successful outcome of DAIR for knee PJI. The results from the meta-regression are presented as a blue line with red 95% CI. Both variables are presented as proportions of all included knees in the study cohort.
Fig. 3
Fig. 3
Scatterplot showing the association between exchange of modular components and successful outcome of hips after debridement, antibiotics, and implant retention (DAIR) procedure. The results from the meta-regression is presented as a blue line with red 95% confidence interval (CI). Both variables are presented as proportions of all included hips in the study cohort. a) represents studies starting cohort inclusion before the year 2004. b) represents studies starting cohort inclusion after the year 2004. Scatterplot showing the association between exchange of modular components and successful outcome of knees after DAIR procedure. The results from the meta-regression is presented as a blue line with red 95% CI. Both variables are presented as proportions of all included knees in the study cohort. c) represents studies starting cohort inclusion before the year 2004. d) represents studies starting cohort inclusion after the year 2004.
See this image and copyright information in PMC

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