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Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases

BACKGROUND: The debridement, antibiotics, and implant retention (DAIR) procedure is an established therapeutic option for periprosthetic knee infections (PKI). However, the efficacy and the indication for this procedure are still controversial. METHODS: All the relevant literatures were systematical...

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Autores principales: Qu, Guo-Xin, Zhang, Cai-Hua, Yan, Shi-Gui, Cai, Xun-Zi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852904/
https://www.ncbi.nlm.nih.gov/pubmed/31718644
http://dx.doi.org/10.1186/s13018-019-1378-4
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author Qu, Guo-Xin
Zhang, Cai-Hua
Yan, Shi-Gui
Cai, Xun-Zi
author_facet Qu, Guo-Xin
Zhang, Cai-Hua
Yan, Shi-Gui
Cai, Xun-Zi
author_sort Qu, Guo-Xin
collection PubMed
description BACKGROUND: The debridement, antibiotics, and implant retention (DAIR) procedure is an established therapeutic option for periprosthetic knee infections (PKI). However, the efficacy and the indication for this procedure are still controversial. METHODS: All the relevant literatures were systematically reviewed and analyzed. The present study aimed to assess the success rate of DAIR in the management of PKI, identify the factors associated with prognosis of DAIR, and establish a simple algorithm for predicting a high success rate of DAIR. RESULTS: Totally, 33 studies with 1266 cases were included. The overall success rate following DAIR in the management of PKI was 57.11%. In the subgroup analyses, the factors of “the time from symptoms to debridement was < 3 weeks” and “the bacterial species other than methicillin-resistant Staphylococcus aureus” significantly improved the success rate of DAIR and thus were defined as the major criteria. The statistically insignificant factors of “the open debridement and liner exchange” and “the comorbidity of rheumatoid arthritis” were set as the minor criteria. The success rate of DAIR for PKI meeting all the major criteria and no less than one minor criterion was 80.98%, which was significantly higher than the overall success rate of DAIR (p < 0.05). CONCLUSION: PKI cases meeting two major criteria and no less than one minor criterion may confer a high success rate of DAIR. This simple algorithm may contribute to identifying the appropriate PKI patient for DAIR treatment and predicting the prognosis of DAIR.
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spelling pubmed-68529042019-11-20 Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases Qu, Guo-Xin Zhang, Cai-Hua Yan, Shi-Gui Cai, Xun-Zi J Orthop Surg Res Systematic Review BACKGROUND: The debridement, antibiotics, and implant retention (DAIR) procedure is an established therapeutic option for periprosthetic knee infections (PKI). However, the efficacy and the indication for this procedure are still controversial. METHODS: All the relevant literatures were systematically reviewed and analyzed. The present study aimed to assess the success rate of DAIR in the management of PKI, identify the factors associated with prognosis of DAIR, and establish a simple algorithm for predicting a high success rate of DAIR. RESULTS: Totally, 33 studies with 1266 cases were included. The overall success rate following DAIR in the management of PKI was 57.11%. In the subgroup analyses, the factors of “the time from symptoms to debridement was < 3 weeks” and “the bacterial species other than methicillin-resistant Staphylococcus aureus” significantly improved the success rate of DAIR and thus were defined as the major criteria. The statistically insignificant factors of “the open debridement and liner exchange” and “the comorbidity of rheumatoid arthritis” were set as the minor criteria. The success rate of DAIR for PKI meeting all the major criteria and no less than one minor criterion was 80.98%, which was significantly higher than the overall success rate of DAIR (p < 0.05). CONCLUSION: PKI cases meeting two major criteria and no less than one minor criterion may confer a high success rate of DAIR. This simple algorithm may contribute to identifying the appropriate PKI patient for DAIR treatment and predicting the prognosis of DAIR. BioMed Central 2019-11-12 /pmc/articles/PMC6852904/ /pubmed/31718644 http://dx.doi.org/10.1186/s13018-019-1378-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Systematic Review
Qu, Guo-Xin
Zhang, Cai-Hua
Yan, Shi-Gui
Cai, Xun-Zi
Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
title Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
title_full Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
title_fullStr Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
title_full_unstemmed Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
title_short Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
title_sort debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852904/
https://www.ncbi.nlm.nih.gov/pubmed/31718644
http://dx.doi.org/10.1186/s13018-019-1378-4
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