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Review
. 2023 Jul 31;12(15):5026.
doi: 10.3390/jcm12155026.

Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

Caspar W J Hulleman  1 , Tommy S de Windt  2 , Karin Veerman  1 , Jon H M Goosen  1 , Frank-Christiaan B M Wagenaar  2 , Gijs G van Hellemondt  1
Affiliations
Review

Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

Caspar W J Hulleman et al. J Clin Med. .

Abstract

Goal: The purpose of this review is to provide a systematic and comprehensive overview of the available literature on the treatment of an early prosthetic joint infection (PJI) after revision total knee arthroplasty (TKA) and provide treatment guidelines.

Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using the electronic databases of PubMed, Trip, Cochrane, Embase, LILACS and SciElo. After the inclusion of the relevant articles, we extracted the data and results to compose a treatment algorithm for early and acute PJI after revision TKA.

Results: After applying the in- and exclusion criteria, seven articles were included in this systematic review focusing on debridement, antibiotics and implant retention (DAIR) for PJI following revision TKA, of which one was prospective and six were retrospective. All studies were qualified as level IV evidence.

Conclusions: The current literature suggests that DAIR is a valid treatment option for early infections after revision TKA with success rates of 50-70%. Repeat DAIR shows success rates of around 50%. Further research should be aimed at predicting successful (repeat/two-stage) DAIRs in larger study populations, antibiotic regimes and the cost effectiveness of a second DAIR after revision TKA.

Keywords: antibiotics and implant retention; debridement; periprosthetic joint infection; revision knee arthroplasty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection. DAIR: debridement, antibiotics and implant retention. PJI: prosthetic joint infection.
Figure 2
Figure 2
Flowchart of treatment algorithm. PJI types based on the classification described by Tsukayama et al. [8].
See this image and copyright information in PMC

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