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Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection : a systematic review
Maxime Gerritsen1,2, Abdullah Khawar1, Henk Scheper2
1Dept. of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
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 Cite this article: Bone Jt Open 2021;2(10):806-812.
Insights
Modular component exchange during debridement, antibiotics, and implant retention (DAIR) for periprosthetic joint infection (PJI) shows no significant benefit. This finding suggests careful consideration of risks and costs versus potential outcomes for infected implants.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biomaterials
Background:
- Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
- The debridement, antibiotics, and implant retention (DAIR) procedure is a common treatment for PJI.
- The role of modular component exchange during DAIR remains debated.
Purpose of the Study:
- To assess the association between modular component exchange during DAIR and treatment outcomes for hip and knee PJI.
- To evaluate if the timing of the procedure influences the success of modular component exchange.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library) until May 2021.
- Random effects meta-analyses and meta-regression were employed to analyze study-level success rates.
- The AQUILA checklist was used for risk of bias appraisal.
Main Results:
- The pooled success rate for DAIR in PJI was 67%, with variations between hip (70%) and knee (63%) PJI.
- Before 2004, increased component exchange correlated with higher success rates for both hip and knee DAIR.
- After 2004, this association diminished, with a slight decrease in success for hip PJI and a minimal increase for knee PJI with increased component exchange.
Conclusions:
- Modular component exchange during DAIR for PJI does not demonstrate a clear benefit in reducing treatment failure.
- The decision to exchange modular components should be individualized, balancing potential risks and costs.
- The changing association over time suggests evolving treatment paradigms and evidence-based practices in managing infected implants.
