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Review
. 2021 Sep 14;6(9):727-734.
doi: 10.1302/2058-5241.6.210008. eCollection 2021 Sep.

Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes

Theofilos Karachalios  1   2 , George A Komnos  1
Affiliations
Review

Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes

Theofilos Karachalios et al. EFORT Open Rev. .

Abstract

DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies.Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance.DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy.Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision.It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon's responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies. Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008.

Keywords: PJI clinical outcomes; functional recovery; quality of life.

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Conflict of interest statement

ICMJE Conflict of interest statement: TK reports consultancy fees paid to his institution by Microport Orthopaedics, for relevant financial activities outside the submitted work. Both authors declare no conflicts of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Intra-operative picture of early steps of one-stage revision surgery for infected total hip arthroplasty (THA).
Fig. 2
Fig. 2
Factors affecting the outcome of different prosthetic joint infection (PJI) treatment strategies are shown.
Fig. 3
Fig. 3
Different steps and variables of one-stage revision strategy are shown. Question marks indicate technical steps for which there is a lack of agreement in the literature. Note. PCR; CRP; ESR.
Fig. 4
Fig. 4
Different steps and variables of two-stage revision strategy are shown. Question marks indicate technical steps for which there is a lack of agreement in the literature. Note. PCR; CRP; ESR.
See this image and copyright information in PMC

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