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Early periprosthetic infection: dilution, jet dilution or local antibiotics. Which way to go? A meta-analysis on 575
Tilman Vees1,2, Gunther O Hofmann1,2
1Clinic of Trauma, Hand und Reconstructive Surgery, Friedrich-Schiller-University Jena, Germany.
Insights
Treating early periprosthetic joint infections (PPI) after hip or knee replacement with dilution, jet dilution, or local antibiotics shows varied success. A meta-analysis found no significant difference between these methods for prosthesis retention.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
Background:
- Periprosthetic joint infections (PPI) following total hip (THA) and total knee arthroplasty (TKA) are classified as early or late.
- Early PPI, occurring within six weeks of surgery, aims for prosthesis retention via dilution, jet dilution, or local antibiotics.
- Current evidence supporting these early PPI treatment strategies is limited.
Purpose of the Study:
- To systematically review and evaluate the success rates of different therapeutic approaches for early periprosthetic joint infections.
- To determine if specific interventions like dilution, jet dilution, or local antibiotics offer superior outcomes in retaining prostheses.
Main Methods:
- A systematic literature review was conducted, including clinical trials published after 1990 that reported success or failure rates for early PPI.
- Data from 10 studies, encompassing 575 patients, were analyzed.
- A meta-analysis using the Scheffé-Test was performed to compare the efficacy of single and combined treatment concepts.
Main Results:
- Treatment success rates varied: dilution alone (49.48%), jet dilution (78.26%), and local antibiotics (55%).
- The meta-analysis revealed no statistically significant difference in success rates among dilution, jet dilution, or local antibiotics.
- Combining local antibiotics with dilution or jet dilution did not yield significantly higher success rates.
Conclusions:
- Despite varied individual study results, the meta-analysis indicates no significant advantage for dilution, jet dilution, local antibiotics, or their combinations in treating early PPI.
- Existing evidence is insufficient to recommend a specific treatment modality for early periprosthetic joint infections to ensure prosthesis retention.
Abstract:
Objective: Periprosthetic infections (PPI) after total hip and total knee arthroplasty (THA, TKA) are subdivided into early and late infections. Early PPIs are defined as the occurrence of infection within 6 weeks following the primary surgery. Aim of therapy in early PPI is the retention of the prosthesis using dilution, jet dilution or local antibiotics. However, as of yet, no evidence is available supporting these procedures. The aim of this study was to evaluate their success rates. Methods: We conducted a systematic literature review of studies reporting on early PPI. Clinical trials published after 1990 that reported success or failure rates as the primary outcome were included. A meta-analysis using the Scheffé-Test showed if there are any advantages of single treatment concepts. Results: We identified 575 patients over 10 studies. Success rates were diverse: Undergoing dilution without jet lavage revealed treatment success in 49.48%, using jet dilution increased the success rate to 78.26%. Local antibiotics were successfully used in 55% of the cases. The meta-analysis compared the three interventions and showed no significant difference in using dilution, jet dilution or local antibiotics. Even combining local antibiotics and dilution/jet dilution does not provide significantly higher success rates. Conclusion: Previous studies showed differences in methods and results, however pooling the data of these studies for our meta-analysis didn't show significant advantages. We therefore conclude that studies conducted until thus far cannot provide any recommendation as to whether using dilution, jet dilution, local antibiotics or any combination of three is better for treating early PPI cases.
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