Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis
| Autor: | Maxime Gerritsen, Abdullah Khawar, Henk Scheper, Robert van der Wal, Jan Schoones, Mark de Boer, Rob Nelissen, Bart Pijls |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
periprosthetic joint infection
dair modular component exchange total joint replacement debridement antibiotics and implant retention hips knee periprosthetic joint infection periprosthetic joint infection (pji) knees regression analysis revision arthroplasties randomized controlled trials debridement lower limb arthroplasties Orthopedic surgery RD701-811 |
| Zdroj: | Bone & Joint Open, Vol 2, Iss 10, Pp 806-812 (2021) |
| Druh dokumentu: | article |
| ISSN: | 2633-1462 |
| DOI: | 10.1302/2633-1462.210.BJO-2021-0090.R1 |
| Popis: | 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 |
| Databáze: | Directory of Open Access Journals |
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