Articles | Volume 10, issue 2
https://doi.org/10.5194/jbji-10-101-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-101-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Guidelines/recommendations/consensus paper
| 
01 Apr 2025
Guidelines/recommendations/consensus paper |
| 01 Apr 2025
| 01 Apr 2025
Debridement, antimicrobial therapy, and implant retention (DAIR) as curative strategy for acute periprosthetic hip and knee infections: a position paper of the European Bone & Joint Infection Society (EBJIS)
Irene K. Sigmund
CORRESPONDING AUTHOR
Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
Tristan Ferry
Infectious and Tropical Diseases Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
Ricardo Sousa
Porto Bone Infection Group (GRIP), Orthopaedic Department, ULS Santo António, Porto, Portugal
Alex Soriano
Hospital Clinic of Barcelona, Barcelona, Spain
IDIBAPS, Barcelona, Spain
CIBERNIF, CIBER in Infectious Diseases, ISCIII, Madrid, Spain
Willem J. Metsemakers
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Martin Clauss
Department of Orthopaedics and Trauma Surgery, Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland
Rihard Trebse
Orthopaedic Hospital Valdoltra, Ankaran, Slovenia
Marjan Wouthuyzen-Bakker
Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Related authors
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem J. Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
Short summary
Short summary
This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem J. Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
Short summary
Short summary
This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
Short summary
Short summary
We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 41–49, https://doi.org/10.5194/jbji-10-41-2025, https://doi.org/10.5194/jbji-10-41-2025, 2025
Short summary
Short summary
This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.
Baixing Chen, T. Fintan Moriarty, Hans Steenackers, Georges F. Vles, Jolien Onsea, Thijs Vackier, Isabel Spriet, Rob Lavigne, R. Geoff Richards, and Willem-Jan Metsemakers
J. Bone Joint Infect., 9, 249–260, https://doi.org/10.5194/jbji-9-249-2024, https://doi.org/10.5194/jbji-9-249-2024, 2024
Short summary
Short summary
Our research explores natural antimicrobials to combat orthopedic-device-related infections, a challenging issue due to antibiotic resistance. We reviewed agents from bacteria, fungi, viruses, animals, plants and minerals, evaluating their effectiveness and synergy with traditional antibiotics. Our findings suggest these natural alternatives could revolutionize infection management in orthopedic patients, offering new hope for reducing antibiotic resistance and improving treatment outcomes.
Laia Boadas-Gironès, Marta Sabater-Martos, Marc Ferrer-Banus, Àlex Soriano-Viladomiu, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 241–248, https://doi.org/10.5194/jbji-9-241-2024, https://doi.org/10.5194/jbji-9-241-2024, 2024
Short summary
Short summary
When acute soft tissue defects are present after knee arthroplasty, the infection risk is high. A gastrocnemius flap is used for anterior defects, and it is not usually combined with debridement surgery unless infection is clear. We examined the benefit of combining coverage treatment with debridement surgery, DAIR, comparing the isolated traditional coverage treatment. The results suggested a higher healing rate in the combined treatment, so we recommended it.
Seung-Jae Yoon, Paul C. Jutte, Alex Soriano, Ricardo Sousa, Wierd P. Zijlstra, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 9, 231–239, https://doi.org/10.5194/jbji-9-231-2024, https://doi.org/10.5194/jbji-9-231-2024, 2024
Short summary
Short summary
This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.
Alexandra Wallimann, Yvonne Achermann, Ciara Ferris, Mario Morgenstern, Martin Clauss, Vincent Stadelmann, Hannes Andreas Rüdiger, Liam O'Mahony, and Thomas Fintan Moriarty
J. Bone Joint Infect., 9, 191–196, https://doi.org/10.5194/jbji-9-191-2024, https://doi.org/10.5194/jbji-9-191-2024, 2024
Short summary
Short summary
Skin commensal bacteria such as staphylococci are often the source of orthopaedic-device-related infections. Rifampicin is a widely used antibiotic in the treatment of these infections. The results of this study show that oral rifampicin therapy leads to a consistent and persistent induction of resistance in commensal staphylococci on the skin and in the nose for a prolonged time.
Noémie Reinert, Katinka Wetzel, Fabian Franzeck, Mario Morgenstern, Markus Aschwanden, Thomas Wolff, Martin Clauss, and Parham Sendi
J. Bone Joint Infect., 9, 183–190, https://doi.org/10.5194/jbji-9-183-2024, https://doi.org/10.5194/jbji-9-183-2024, 2024
Short summary
Short summary
We assessed concordance of in-house guidelines for diagnostic principles and antibiotic treatment duration (ABT) 2 years after their implementation. The goal was to standardize diagnostic and treatment principles: are we doing what we recommend? The adherence to recommendations in terms of biopsy sampling was good, moderate for histopathology and poor for anatomic labeling. In terms of ABT duration, the adherence was good, but further shortening for surgically cured cases is necessary.
Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
J. Bone Joint Infect., 9, 167–171, https://doi.org/10.5194/jbji-9-167-2024, https://doi.org/10.5194/jbji-9-167-2024, 2024
Short summary
Short summary
The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
Short summary
Short summary
This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Céline Dupieux, Ghislaine Descours, Paul Verhoeven, Florence Grattard, Yvonne Benito, François Vandenesch, Céline Cazorla, Tristan Ferry, Sébastien Lustig, Bertrand Boyer, Sandrine Boisset, Anne Carricajo, Frédéric Laurent, and PIRLA investigator group
J. Bone Joint Infect., 9, 37–48, https://doi.org/10.5194/jbji-9-37-2024, https://doi.org/10.5194/jbji-9-37-2024, 2024
Short summary
Short summary
We define an algorithm to optimize bone and joint infection diagnosis in adults on synovial fluid samples. This prospective multi-center study included a large number of synovial fluids and compared the performance of classical culture on different media, inoculation of synovial fluid in blood culture bottles, and broad-range and specific PCR. We proposed an algorithm associating culture onto three solid media and into blood culture bottles and 16S, Staphylococcus, and Streptococcus PCR.
Jordi Cools, Stijn Ghijselings, Fred Ruythooren, Sander Jentjens, Nathalie Noppe, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 9, 27–35, https://doi.org/10.5194/jbji-9-27-2024, https://doi.org/10.5194/jbji-9-27-2024, 2024
Short summary
Short summary
Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency. To date, the role of advanced imaging has been confined to supporting or opposing diagnosis; however, implications for surgical decision-making and outcomes have not yet been established. We found that extra-articular abscesses are present in two out of three patients and require varying anatomical approaches. Therefore, we recommend routinely performing advanced imaging in all adults with SA of the native hip joint.
Marta Sabater-Martos, Marc Ferrer, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 17–26, https://doi.org/10.5194/jbji-9-17-2024, https://doi.org/10.5194/jbji-9-17-2024, 2024
Short summary
Short summary
This is a meta-analysis of six studies describing the cutoff values of white blood cell count and polymorphonuclear percentage in synovial fluid for the diagnosis of acute postoperative peri-prosthetic joint infection (PJI).
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
Fred Ruythooren, Stijn Ghijselings, Jordi Cools, Melissa Depypere, Paul De Munter, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 8, 209–218, https://doi.org/10.5194/jbji-8-209-2023, https://doi.org/10.5194/jbji-8-209-2023, 2023
Short summary
Short summary
A total of 41 patients who underwent surgical treatment for septic arthritis (SA) of the native hip were studied. We show that patients with SA of the native hip can be divided in three distinct clinical subgroups based on route of infection. Route of infection is directly related to the chance of femoral head preservation and should, therefore, be the basis for decision-making. Only patients with blood-borne infections in an undamaged hip had a reasonable chance of femoral head preservation.
Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
Short summary
Short summary
This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Sara Elisa Diniz, Ana Ribau, André Vinha, José Carlos Oliveira, Miguel Araújo Abreu, and Ricardo Sousa
J. Bone Joint Infect., 8, 109–118, https://doi.org/10.5194/jbji-8-109-2023, https://doi.org/10.5194/jbji-8-109-2023, 2023
Short summary
Short summary
While there is no gold standard test to diagnose periprosthetic joint infection (PJI), we believe synovial fluid analysis, especially preoperatively, is a critical step in differentiating between infection and aseptic failure. Adding simple and inexpensive biomarkers such as synovial C-reactive protein (CRP) or adenosine deaminase (ADA) and combined interpretation can be helpful in the context of inconclusive results.
Jorrit Willem Adriaan Schoenmakers, Rosanne de Boer, Lilli Gard, Greetje Anna Kampinga, Marleen van Oosten, Jan Maarten van Dijl, Paulus Christiaan Jutte, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 8, 45–50, https://doi.org/10.5194/jbji-8-45-2023, https://doi.org/10.5194/jbji-8-45-2023, 2023
Short summary
Short summary
In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.
Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
Short summary
Short summary
Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, Alba Ribera, Javier Ariza, María Dolores del Toro, Sophie Nguyen, Eric Senneville, Eric Bonnet, Monica Chan, Maria Bruna Pasticci, Sabine Petersdorf, Natividad Benito, Nuala O' Connell, Antonio Blanco García, Gábor Skaliczki, Pierre Tattevin, Zeliha Kocak Tufan, Nikolaos Pantazis, Panayiotis D. Megaloikonomos, Panayiotis Papagelopoulos, Alejandro Soriano, Antonios Papadopoulos, and the ESGIAI collaborators study group
J. Bone Joint Infect., 7, 279–288, https://doi.org/10.5194/jbji-7-279-2022, https://doi.org/10.5194/jbji-7-279-2022, 2022
Short summary
Short summary
Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.
Parham Sendi and Tristan Ferry
J. Bone Joint Infect., 7, 187–189, https://doi.org/10.5194/jbji-7-187-2022, https://doi.org/10.5194/jbji-7-187-2022, 2022
Clément Javaux, Clémentine Daveau, Clotilde Bettinger, Mathieu Daurade, Céline Dupieux-Chabert, Fabien Craighero, Carine Fuchsmann, Philippe Céruse, Arnaud Gleizal, Nicolas Sigaux, Tristan Ferry, Florent Valour, and the Lyon BJI study group
J. Bone Joint Infect., 7, 127–136, https://doi.org/10.5194/jbji-7-127-2022, https://doi.org/10.5194/jbji-7-127-2022, 2022
Short summary
Short summary
We describe 48 osteocutaneous-flap-related osteomyelitis cases, mostly presenting with early, local signs of infection and/or bone exposure. Main pathogens were Gram-negative bacilli, streptococci, S. aureus, enterococci, and anaerobes, justifying a broad-spectrum empirical antimicrobial therapy. Despite surgery and a 3-month antimicrobial therapy, a 50 % failure rate was recorded, associated with a delayed infectious disease specialist referral and advocating for multidisciplinary management.
Ernesto Muñoz-Mahamud, Eduard Tornero, José A. Estrada, Jenaro A. Fernández-Valencia, Juan C. Martínez-Pastor, and Álex Soriano
J. Bone Joint Infect., 7, 109–115, https://doi.org/10.5194/jbji-7-109-2022, https://doi.org/10.5194/jbji-7-109-2022, 2022
Short summary
Short summary
A patient with normal D-dimer value has a low risk of prosthetic joint infection, so serum D-dimer assessment should always be considered as a useful test to rule out chronic prosthetic joint infection (especially in those cases caused by low-virulence microorganisms in which conventional tests may lead to misdiagnosis). Conversely, the platelet count to mean platelet volume ratio may be of limited value for accurately diagnosing prosthetic joint infection.
Marjan Wouthuyzen-Bakker and Alexander L. Boerboom
J. Bone Joint Infect., 7, 33–34, https://doi.org/10.5194/jbji-7-33-2022, https://doi.org/10.5194/jbji-7-33-2022, 2022
Short summary
Short summary
This case illustrates the clinical picture of a worn-out elbow prosthesis resulting in severe metallosis and a subsequent periprosthetic joint infection.
Karsten D. Ottink, Stefan J. Gelderman, Marjan Wouthuyzen-Bakker, Joris J. W. Ploegmakers, Andor W. J. M. Glaudemans, and Paul C. Jutte
J. Bone Joint Infect., 7, 1–9, https://doi.org/10.5194/jbji-7-1-2022, https://doi.org/10.5194/jbji-7-1-2022, 2022
Short summary
Short summary
A low-grade periprosthetic joint infection (PJI) may be difficult to diagnose, and nuclear imaging could help in the diagnosis. However, its diagnostic value is unclear. We retrospectively evaluated this diagnostic value. We conclude that in patients presenting with nonspecific symptoms and a low a priori chance of PJI based on clinical evaluation, nuclear imaging is of no clear added value in diagnosing a PJI.
Simon Martin Heinrich, Parham Sendi, and Martin Clauss
J. Bone Joint Infect., 6, 423–424, https://doi.org/10.5194/jbji-6-423-2021, https://doi.org/10.5194/jbji-6-423-2021, 2021
Short summary
Short summary
We report on an 83-year-old woman who had an open removal of a baker's cyst several months after total knee arthroplasty. The following wound healing problem was first misinterpreted as being superficial. With an injection of methylene blue and a contrast medium, we showed the extent of the sinus tract, proving the periprosthetic joint infection.
Truong-Thanh Pham, Eugénie Mabrut, Philippe Cochard, Paul Chardon, Hassan Serrier, Florent Valour, Laure Huot, Michel Tod, Gilles Leboucher, Christian Chidiac, and Tristan Ferry
J. Bone Joint Infect., 6, 337–346, https://doi.org/10.5194/jbji-6-337-2021, https://doi.org/10.5194/jbji-6-337-2021, 2021
Short summary
Short summary
Costs related to off-label expensive antibiotics used to treat bone and joint infections (BJIs) in a referral centre in France were analysed in this cohort study. Despite the large increase in the number of patients treated with these antibiotics, the overall costs remained stable (approximately EUR 1 million) and were helped by the appearance of generic molecules at lower prices. Production of generic antibiotics at low cost is essential to limit the financial burden of the management of BJIs.
Karel-Jan Dag François Lensen, Rosa Escudero-Sanchez, Javier Cobo, Rihard Trebše, Camelia Gubavu, Sara Tedeschi, Jose M. Lomas, Cedric Arvieux, Dolors Rodriguez-Pardo, Massimo Fantoni, Maria Jose Garcia Pais, Francisco Jover, Mauro José Costa Salles, Ignacio Sancho, Marta Fernandez Sampedro, Alex Soriano, Marjan Wouthuyzen-Bakker, and ESCMID Study Group of Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 6, 313–319, https://doi.org/10.5194/jbji-6-313-2021, https://doi.org/10.5194/jbji-6-313-2021, 2021
Short summary
Short summary
Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.
André Dias Carvalho, Ana Ribau, Daniel Soares, Ana Claudia Santos, Miguel Abreu, and Ricardo Sousa
J. Bone Joint Infect., 6, 305–312, https://doi.org/10.5194/jbji-6-305-2021, https://doi.org/10.5194/jbji-6-305-2021, 2021
Short summary
Short summary
When we initiated this paper, there was no evidence on what kind of spacers we should use. Our work was to prove that we must use a broad spectrum of antibiotics at the spacers in two-stage revision procedures. We demonstrate that a large spectrum of antibiotics at the spacer results in a lower rate of positive cultures during preimplantation and, subsequently, better outcomes and lower rate of infection.
Ernesto Muñoz-Mahamud, Jenaro Ángel Fernández-Valencia, Andreu Combalia, Laura Morata, and Álex Soriano
J. Bone Joint Infect., 6, 85–90, https://doi.org/10.5194/jbji-6-85-2021, https://doi.org/10.5194/jbji-6-85-2021, 2021
Short summary
Short summary
A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.
Karel-Jan Lensen, Rosa Escudero-Sanchez, Javier Cobo, Alex Soriano, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 6, 43–45, https://doi.org/10.5194/jbji-6-43-2020, https://doi.org/10.5194/jbji-6-43-2020, 2020
Agathe Becker, Louis Kreitmann, and Tristan Ferry
J. Bone Joint Infect., 6, 19–20, https://doi.org/10.5194/jbji-6-19-2020, https://doi.org/10.5194/jbji-6-19-2020, 2020
Cited articles
Abdi-Ali, A., Mohammadi-Mehr, M., and Agha Alaei, Y.: Bactericidal activity of various antibiotics against biofilm-producing Pseudomonas aeruginosa, Int. J. Aantimicrob. Agents, 27, 196–200, https://doi.org/10.1016/j.ijantimicag.2005.10.007, 2006.
Aiken, S. S., Cooper, J. J., Florance, H., Robinson, M. T., and Michell, S.: Local release of antibiotics for surgical site infection management using high-purity calcium sulfate: an in vitro elution study, Surg. Infect., 16, 54–61, https://doi.org/10.1089/sur.2013.162, 2015.
Alvand, A., Grammatopoulos, G., de Vos, F., Scarborough, M., Kendrick, B., Price, A., Gundle, R., Whitwell, D., Jackson, W., Taylor, A., and Gibbons, C.: Clinical Outcome of Massive Endoprostheses Used for Managing Periprosthetic Joint Infections of the Hip and Knee, J. Arthroplast., 33, 829–834, https://doi.org/10.1016/j.arth.2017.09.046, 2018.
Annane, D., Aegerter, P., Jars-Guincestre, M. C., and Guidet, B.: Current epidemiology of septic shock: the CUB-Réa Network, Am. J. Respirat. Crit. Care Med., 168, 165–172, https://doi.org/10.1164/rccm.2201087, 2003.
Argenson, J. N., Arndt, M., Babis, G., Battenberg, A., Budhiparama, N., Catani, F., Chen, F., de Beaubien, B., Ebied, A., Esposito, S., Ferry, C., Flores, H., Giorgini, A., Hansen, E., Hernugrahanto, K. D., Hyonmin, C., Kim, T. K., Koh, I. J., Komnos, G., Lausmann, C., Loloi, J., Lora-Tamayo, J., Lumban-Gaol, I., Mahyudin, F., Mancheno-Losa, M., Marculescu, C., Marei, S., Martin, K. E., Meshram, P., Paprosky, W. G., Poultsides, L., Saxena, A., Schwechter, E., Shah, J., Shohat, N., Sierra, R. J., Soriano, A., Stefánsdóttir, A., Suleiman, L. I., Taylor, A., Triantafyllopoulos, G. K., Utomo, D. N., Warren, D., Whiteside, L., Wouthuyzen-Bakker, M., Yombi, J., and Zmistowski, B.: Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections, J. Arthroplast., 34, 399–419, https://doi.org/10.1016/j.arth.2018.09.025, 2019.
Asokan, A., Ibrahim, M. S., Thompson, J. W., and Haddad, F. S.: Debridement, antibiotics, and implant retention in non-oncological femoral megaprosthesis infections: minimum 5 year follow-up, J. Exp. Orthopaed., 9, 32, https://doi.org/10.1186/s40634-022-00469-9, 2022.
Azzam, K. A., Seeley, M., Ghanem, E., Austin, M. S., Purtill, J. J., and Parvizi, J.: Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited, J. Arthroplast., 25, 1022–1027, https://doi.org/10.1016/j.arth.2010.01.104, 2010.
Bartsch, A., Krenn, P., Lubberts, B., Morgenstern, M., Pagenstert, G., and Clauss, M.: Management of acute periprosthetic knee infection: a comparison of arthroscopic and open debridement, Arch. Orthopaed. Traumat. Surg., 143, 4309–4316, https://doi.org/10.1007/s00402-023-04782-5, 2023.
Becker, A., Kreitmann, L., Triffaut-Fillit, C., Valour, F., Mabrut, E., Forestier, E., Lesens, O., Cazorla, C., Descamps, S., Boyer, B., Chidiac, C., Lustig, S., Montbarbon, E., Batailler, C., and Ferry, T.: Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France, J. Bone Joint Infect., 5, 28–34, https://doi.org/10.7150/jbji.40333, 2020.
Bedair, H. S., Katakam, A., Bedeir, Y. H., Yeroushalmi, D., and Schwarzkopf, R.: A decision analysis of treatment strategies for acute periprosthetic joint infection: Early irrigation and debridement versus delayed treatment based on organism, J. Orthopaed., 22, 246–250, https://doi.org/10.1016/j.jor.2020.04.003, 2020.
Beldman, M., Löwik, C., Soriano, A., Albiach, L., Zijlstra, W. P., Knobben, B. A. S., Jutte, P., Sousa, R., Carvalho, A., Goswami, K., Parvizi, J., Belden, K. A., and Wouthuyzen-Bakker, M.: If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study, Clin. Infect. Dis., 73, 1634–1641, https://doi.org/10.1093/cid/ciab426, 2021.
Bernard, L., Arvieux, C., Brunschweiler, B., Touchais, S., Ansart, S., Bru, J. P., Oziol, E., Boeri, C., Gras, G., Druon, J., Rosset, P., Senneville, E., Bentayeb, H., Bouhour, D., Le Moal, G., Michon, J., Aumaître, H., Forestier, E., Laffosse, J. M., Begué, T., Chirouze, C., Dauchy, F. A., Devaud, E., Martha, B., Burgot, D., Boutoille, D., Stindel, E., Dinh, A., Bemer, P., Giraudeau, B., Issartel, B., and Caille, A.: Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection, N. Engl. J. Med., 384, 1991–2001, https://doi.org/10.1056/NEJMoa2020198, 2021.
Bernaus, M., Auñón-Rubio, Á., Monfort-Mira, M., Arteagoitia-Colino, I., Martínez-Ros, J., Castellanos, J., Lamo-Espinosa, J. M., Argüelles, F., Veloso, M., Gómez García, L., Crespo, F. A., Sánchez-Fernández, J., Murias-Álvarez, J., Martí-Garín, D., Hernández-González, N., Villarejo-Fernández, B., Valero-Cifuentes, G., Hernández-Torres, A., Molina-González, J., Coifman-Lucena, I., Esteban-Moreno, J., Demaria, P., Esteve-Palau, E., Del Pozo, J. L., Suárez, Á., Carmona-Torre, F., Darás, Á., Baeza, J., and Font-Vizcarra, L.: Risk Factors of DAIR Failure and Validation of the KLIC Score: A Multicenter Study of Four Hundred Fifty-Five Patients, Surg. Infect., 23, 280–287, https://doi.org/10.1089/sur.2021.320, 2022.
Brandt, C. M., Sistrunk, W. W., Duffy, M. C., Hanssen, A. D., Steckelberg, J. M., Ilstrup, D. M., and Osmon, D. R.: Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention, Clin. Infect. Dis., 24, 914–919, https://doi.org/10.1093/clinids/24.5.914, 1997.
Bruyninckx, S., Metsemakers, W. J., Depypere, M., Henckaerts, L., van den Hout, E., Onsea, J., Ghijselings, S., and Vles, G. F.: Local antibiotic delivery via intra-articular catheter infusion for the treatment of periprosthetic joint infection: a systematic review, Arch. Orthopaed. Traumat. Surg., 144, 5177–5189, https://doi.org/10.1007/s00402-024-05341-2, 2024.
Bryan, A. J., Abdel, M. P., Sanders, T. L., Fitzgerald, S. F., Hanssen, A. D., and Berry, D. J.: Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management, J. Bone Joint Surg., 99, 2011–2018, https://doi.org/10.2106/jbjs.16.01103, 2017.
Byren, I., Bejon, P., Atkins, B. L., Angus, B., Masters, S., McLardy-Smith, P., Gundle, R., and Berendt, A.: One hundred and twelve infected arthroplasties treated with `DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome, J. Antimicrob. Chemother., 63, 1264–1271, https://doi.org/10.1093/jac/dkp107, 2009.
Chaiyakit, P., Meknavin, S., Hongku, N., and Onklin, I.: Debridement, antibiotics, and implant retention combined with direct intra-articular antibiotic infusion in patients with acute hematogenous periprosthetic joint infection of the knee, BMC Musculoskelet. Disord., 22, 557, https://doi.org/10.1186/s12891-021-04451-x, 2021.
Chalmers, B. P., Kapadia, M., Chiu, Y. F., Miller, A. O., Henry, M. W., Lyman, S., and Carli, A. V.: Accuracy of Predictive Algorithms in Total Hip and Knee Arthroplasty Acute Periprosthetic Joint Infections Treated With Debridement, Antibiotics, and Implant Retention (DAIR), J. Arthroplast., 36, 2558–2566, https://doi.org/10.1016/j.arth.2021.02.039, 2021.
Chang, M. J., Ro, D. H., Kim, T. W., Lee, Y. S., Han, H. S., Chang, C. B., Kang, S. B., and Lee, M. C.: Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study, Knee Surg. Relat. Res., 34, 38, https://doi.org/10.1186/s43019-022-00165-z, 2022.
Chang, R. W., Pellisier, J. M., and Hazen, G. B.: A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip, J. Am. Med. Assoc., 275, 858–865, 1996.
Chaussade, H., Uçkay, I., Vuagnat, A., Druon, J., Gras, G., Rosset, P., Lipsky, B. A., and Bernard, L.: Antibiotic therapy duration for prosthetic joint infections treated by Debridement and Implant Retention (DAIR): Similar long-term remission for 6 weeks as compared to 12 weeks, Int. J. Infect. Dis., 63, 37–42, https://doi.org/10.1016/j.ijid.2017.08.002, 2017.
Clauss, M., Hunkeler, C., Manzoni, I., and Sendi, P.: Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection, J. Bone Joint Infect., 5, 35–42, https://doi.org/10.7150/jbji.40924, 2020.
Cobo, J., Miguel, L. G., Euba, G., Rodríguez, D., García-Lechuz, J. M., Riera, M., Falgueras, L., Palomino, J., Benito, N., del Toro, M. D., Pigrau, C., and Ariza, J.: Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy, Clin. Microbiol. Infect., 17, 1632–1637, https://doi.org/10.1111/j.1469-0691.2010.03333.x, 2011.
Cooper, J. J., Florance, H., McKinnon, J. L., Laycock, P. A., and Aiken, S. S.: Elution profiles of tobramycin and vancomycin from high-purity calcium sulphate beads incubated in a range of simulated body fluids, J. Biomateri. Appl., 31, 357–365, https://doi.org/10.1177/0885328216663392, 2016.
Davies, D.: Understanding biofilm resistance to antibacterial agents, Nature reviews, Drug Discov., 2, 114–122, https://doi.org/10.1038/nrd1008, 2003.
Davis, J. S., Metcalf, S., Clark, B., Robinson, J. O., Huggan, P., Luey, C., McBride, S., Aboltins, C., Nelson, R., Campbell, D., Solomon, L. B., Schneider, K., Loewenthal, M. R., Yates, P., Athan, E., Cooper, D., Rad, B., Allworth, T., Reid, A., Read, K., Leung, P., Sud, A., Nagendra, V., Chean, R., Lemoh, C., Mutalima, N., Tran, T., Grimwade, K., Sehu, M., Looke, D., Torda, A., Aung, T., Graves, S., Paterson, D. L., and Manning, L.: Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients, Open Forum Infect. Dis., 9, ofac048, https://doi.org/10.1093/ofid/ofac048, 2022.
De Meo, D., Martini, P., Pennarola, M. F., Guarascio, G., Rivano Capparuccia, M., Iaiani, G., Candela, V., Gumina, S., and Villani, C.: Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study, Gels, 9, 758, https://doi.org/10.3390/gels9090758, 2023.
Deng, W., Li, R., Shao, H., Yu, B., Chen, J., and Zhou, Y.: Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract, BMC Musculoskelet. Disord., 22, 895, https://doi.org/10.1186/s12891-021-04756-x, 2021.
Di Bonaventura, G., Spedicato, I., D'Antonio, D., Robuffo, I., and Piccolomini, R.: Biofilm formation by Stenotrophomonas maltophilia: modulation by quinolones, trimethoprim-sulfamethoxazole, and ceftazidime, Antimicrob. Agents Chemother., 48, 151–160, https://doi.org/10.1128/aac.48.1.151-160.2004, 2004.
Dudareva, M., Barrett, L., Figtree, M., Scarborough, M., Watanabe, M., Newnham, R., Wallis, R., Oakley, S., Kendrick, B., Stubbs, D., McNally, M. A., Bejon, P., Atkins, B. A., Taylor, A., and Brent, A. J.: Sonication versus tissue sampling for diagnosis of prosthetic joint and other orthopaedic device-related infections, J. Clin. Microbiol., 56, e00688-18, https://doi.org/10.1128/jcm.00688-18, 2018.
Dusane, D. H., Brooks, J. R., Sindeldecker, D., Peters, C. W., Li, A., Farrar, N. R., Diamond, S. M., Knecht, C. S., Plaut, R. D., Delury, C., Aiken, S. S., Laycock, P. A., Sullivan, A., Granger, J. F., and Stoodley, P.: Complete Killing of Agar Lawn Biofilms by Systematic Spacing of Antibiotic-Loaded Calcium Sulfate Beads, Materials, 12, 4052, https://doi.org/10.3390/ma12244052, 2019.
Dx Duffy, S., Ahearn, N., Darley, E. S., Porteous, A. J., Murray, J. R., and Howells, N. R.: Analysis Of The KLIC-score; An Outcome Predictor Tool For Prosthetic Joint Infections Treated With Debridement, Antibiotics And Implant Retention, J. Bone Joint Infect., 3, 150–155, https://doi.org/10.7150/jbji.21846, 2018.
Dzaja, I., Howard, J., Somerville, L., and Lanting, B.: Functional outcomes of acutely infected knee arthroplasty: a comparison of different surgical treatment options, Can. J. Surg., 58, 402–407, https://doi.org/10.1503/cjs.017614, 2015.
El Helou, O. C., Berbari, E. F., Lahr, B. D., Eckel-Passow, J. E., Razonable, R. R., Sia, I. G., Virk, A., Walker, R. C., Steckelberg, J. M., Wilson, W. R., Hanssen, A. D., and Osmon, D. R.: Efficacy and safety of rifampin containing regimen for staphylococcal prosthetic joint infections treated with debridement and retention, Euro. J. Clin. Mcrobiol. Infect. Dis., 29, 961–967, https://doi.org/10.1007/s10096-010-0952-9, 2010.
Eriksson, H. K., Lazarinis, S., Järhult, J. D., and Hailer, N. P.: Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant Retention (DAIR): Inferior Outcomes in Patients with Staphylococci Resistant to Rifampicin, Antibiotics, 12, 1589, https://doi.org/10.3390/antibiotics12111589, 2023.
Ethgen, O., Bruyère, O., Richy, F., Dardennes, C., and Reginster, J. Y.: Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature, J. Bone Joint Surg., 86, 963–974, https://doi.org/10.2106/00004623-200405000-00012, 2004.
Everhart, J. S., Altneu, E., and Calhoun, J. H.: Medical comorbidities are independent preoperative risk factors for surgical infection after total joint arthroplasty, Clin. Orthopaed. Relat. Res., 471, 3112–3119, https://doi.org/10.1007/s11999-013-2923-9, 2013.
Ferry, T., Kolenda, C., Batailler, C., Gustave, C. A., Lustig, S., Malatray, M., Fevre, C., Josse, J., Petitjean, C., Chidiac, C., Leboucher, G., and Laurent, F.: Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing S. aureus Prosthetic Knee Infection, Front. Med., 7, 570572, https://doi.org/10.3389/fmed.2020.570572, 2020.
Ferry, T., Batailler, C., Souche, A., Cassino, C., Chidiac, C., Perpoint, T., le Corvaisier, C., Josse, J., Gaillard, R., Roger, J., Kolenda, C., Lustig, S., and Laurent, F.: Arthroscopic “Debridement and Implant Retention” With Local Administration of Exebacase (Lysin CF-301) Followed by Suppressive Tedizolid as Salvage Therapy in Elderly Patients for Relapsing Multidrug-Resistant S. epidermidis Prosthetic Knee Infection, Front. Med., 8, 550853, https://doi.org/10.3389/fmed.2021.550853, 2021.
Ferry, T., Onsea, J., Roussel-Gaillard, T., Batailler, C., Moriarty, T. F., and Metsemakers, W. J.: Bacteriophage therapy in musculoskeletal infections: from basic science to clinical application, EFORT Open Rev., 9, 339–348, https://doi.org/10.1530/eor-24-0042, 2024.
Fink, B., Schuster, P., Schwenninger, C., Frommelt, L., and Oremek, D.: A Standardized Regimen for the Treatment of Acute Postoperative Infections and Acute Hematogenous Infections Associated With Hip and Knee Arthroplasties, Jo. Arthroplast., 32, 1255–1261, https://doi.org/10.1016/j.arth.2016.10.011, 2017.
Fischbacher, A., Peltier, K., and Borens, O.: Economic Analysis in a Diagnosis Related Groups System for Two-stage Exchange of Prosthetic-joint Infections, J. Bone Joint Infect., 3, 249–254, https://doi.org/10.7150/jbji.26146, 2018.
Flierl, M. A., Culp, B. M., Okroj, K. T., Springer, B. D., Levine, B. R., and Della Valle, C. J.: Poor Outcomes of Irrigation and Debridement in Acute Periprosthetic Joint Infection With Antibiotic-Impregnated Calcium Sulfate Beads, J. Arthroplast., 32, 2505–2507, https://doi.org/10.1016/j.arth.2017.03.051, 2017.
Garvin, K. L. and Hanssen, A. D.: Infection after total hip arthroplasty. Past, present, and future, J. Bone Joint Surg., 77, 1576–1588, 1995.
Gerritsen, M., Khawar, A., Scheper, H., van der Wal, R., Schoones, J., de Boer, M., Nelissen, R., and Pijls, B.: Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis, Bone Jt. Open, 2, 806–812, https://doi.org/10.1302/2633-1462.210.Bjo-2021-0090.R1, 2021.
Grammatopoulos, G., Bolduc, M. E., Atkins, B. L., Kendrick, B. J. L., McLardy-Smith, P., Murray, D. W., Gundle, R., and Taylor, A. H.: Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study, Bone Joint J., 99b, 614–622, https://doi.org/10.1302/0301-620x.99b5.Bjj-2016-0562.R2, 2017a.
Grammatopoulos, G., Kendrick, B., McNally, M., Athanasou, N. A., Atkins, B., McLardy-Smith, P., Taylor, A., and Gundle, R.: Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection – An 18-Year Experience, J. Arthroplast., 32, 2248–2255, https://doi.org/10.1016/j.arth.2017.02.066, 2017b.
Gundtoft, P. H., Overgaard, S., Schønheyder, H. C., Møller, J. K., Kjærsgaard-Andersen, P., and Pedersen, A. B.: The “true” incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties: a prospective cohort study, Acta Orthopaed., 86, 326–334, https://doi.org/10.3109/17453674.2015.1011983, 2015.
Haddad, F. S., Ngu, A., and Negus, J. J.: Prosthetic Joint Infections and Cost Analysis?, Adv. Exp. Med. Biol., 971, 93–100, https://doi.org/10.1007/5584_2016_155, 2017.
Hamad, C., Chowdhry, M., Sindeldecker, D., Bernthal, N. M., Stoodley, P., and McPherson, E. J.: Adaptive antimicrobial resistance, a description of microbial variants, and their relevance to periprosthetic joint infection, Bone Joint J., 104b, 575–580, https://doi.org/10.1302/0301-620x.104b5.Bjj-2021-1759.R1, 2022.
Holmberg, A., Thórhallsdóttir, V. G., Robertsson, O., A, W. D., and Stefánsdóttir, A.: 75 % success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections, Acta Orthopaed., 86, 457–462, https://doi.org/10.3109/17453674.2015.1026756, 2015.
Huang, D. B., Brothers, K. M., Mandell, J. B., Taguchi, M., Alexander, P. G., Parker, D. M., Shinabarger, D., Pillar, C., Morrissey, I., Hawser, S., Ghahramani, P., Dobbins, D., Pachuda, N., Montelaro, R., Steckbeck, J. D., and Urish, K. L.: Engineered peptide PLG0206 overcomes limitations of a challenging antimicrobial drug class, PloS One, 17, e0274815, https://doi.org/10.1371/journal.pone.0274815, 2022.
Huotari, K., Peltola, M., and Jämsen, E.: The incidence of late prosthetic joint infections: a registry-based study of 112,708 primary hip and knee replacements, Acta Orthopaed., 86, 321–325, https://doi.org/10.3109/17453674.2015.1035173, 2015.
ICM: Part II Hip and Knee, https://icmphilly.com/wp-content/uploads/2018/11/Hip-and-Knee.pdf (last access: 21 March 2025), 2018.
Jaberi, F. M., Parvizi, J., Haytmanek, C. T., Joshi, A., and Purtill, J.: Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty, Clin. Orthopaed. Relat. Res., 466, 1368–1371, https://doi.org/10.1007/s11999-008-0214-7, 2008.
Jacobs, A. M. E., Valkering, L. J. J., Bénard, M., Meis, J. F., and Goosen, J. H. M.: Evaluation One Year after DAIR Treatment in 91 Suspected Early Prosthetic Joint Infections in Primary Knee and Hip Arthroplasty, J. Bone Joint Infect., 4, 238–244, https://doi.org/10.7150/jbji.37757, 2019.
Jiménez-Garrido, C., Gómez-Palomo, J. M., Rodríguez-Delourme, I., Durán-Garrido, F. J., Nuño-Álvarez, E., and Montañez-Heredia, E.: The Kidney, Liver, Index surgery and C reactive protein score is a predictor of treatment response in acute prosthetic joint infection, Int. Oorthopaed., 42, 33–38, https://doi.org/10.1007/s00264-017-3670-4, 2018.
Johns, B. P., Loewenthal, M. R., Davis, J. S., and Dewar, D. C.: Open Debridement is Superior to Arthroscopic Debridement for the Infected Total Knee Arthroplasty, J. Arthroplast., 35, 3716–3723, https://doi.org/10.1016/j.arth.2020.06.039, 2020.
Kallala, R. and Haddad, F. S.: Hypercalcaemia following the use of antibiotic-eluting absorbable calcium sulphate beads in revision arthroplasty for infection, Bone Joint J., 97b, 1237–1241, https://doi.org/10.1302/0301-620x.97b9.34532, 2015.
Kallala, R., Harris, W. E., Ibrahim, M., Dipane, M., and McPherson, E.: Use of Stimulan absorbable calcium sulphate beads in revision lower limb arthroplasty: Safety profile and complication rates, Bone Joint Res., 7, 570–579, https://doi.org/10.1302/2046-3758.710.Bjr-2017-0319.R1, 2018.
Karczewski, D., Winkler, T., Renz, N., Trampuz, A., Lieb, E., Perka, C., and Muller, M.: A standardized interdisciplinary algorithm for the treatment of prosthetic joint infections, Bone Joint J., 101b, 132–139, https://doi.org/10.1302/0301-620x.101b2.Bjj-2018-1056.R1, 2019.
Katakam, A., Melnic, C. M., and Bedair, H. S.: Morbid Obesity Is a Risk Factor for Infection Recurrence Following Debridement, Antibiotics, and Implant Retention for Periprosthetic Joint Infection, J. Arthroplast., 35, 3710–3715, https://doi.org/10.1016/j.arth.2020.07.005, 2020a.
Katakam, A., Melnic, C. M., and Bedair, H. S.: Dual Surgical Setup May Improve Infection Control Rate of Debridement and Implant Retention Procedures for Periprosthetic Infections of the Hip and Knee, J. Arthroplast., 35, 2590–2594, https://doi.org/10.1016/j.arth.2020.04.068, 2020b.
Katz, J. N., Arant, K. R., and Loeser, R. F.: Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review, J. Am. Med. Assoc., 325, 568–578, https://doi.org/10.1001/jama.2020.22171, 2021.
Knecht, C. S., Moley, J. P., McGrath, M. S., Granger, J. F., Stoodley, P., and Dusane, D. H.: Antibiotic loaded calcium sulfate bead and pulse lavage eradicates biofilms on metal implant materials in vitro, J. Orthopaed. Res., 36, 2349–2354, https://doi.org/10.1002/jor.23903, 2018.
Knoll, L., Steppacher, S. D., Furrer, H., Thurnheer-Zürcher, M. C., and Renz, N.: High treatment failure rate in haematogenous compared to non-haematogenous periprosthetic joint infection, Bone Joint J., 105b, 1294–1302, https://doi.org/10.1302/0301-620x.105b12.Bjj-2023-0454.R1, 2023.
Koh, I. J., Han, S. B., In, Y., Oh, K. J., Lee, D. H., and Kim, T. K.: Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty, Arch. Orthopaed. Traumati. Surg., 135, 847–855, https://doi.org/10.1007/s00402-015-2237-3, 2015.
Kruse, C. C., Ekhtiari, S., Oral, I., Selznick, A., Mundi, R., Chaudhry, H., Pincus, D., Wolfstadt, J., and Kandel, C. E.: The Use of Rifampin in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Comparative Studies, J. Arthroplast., 37, 1650–1657, https://doi.org/10.1016/j.arth.2022.03.072, 2022.
Kuiper, J. W., Vos, S. J., Saouti, R., Vergroesen, D. A., Graat, H. C., Debets-Ossenkopp, Y. J., Peters, E. J., and Nolte, P. A.: Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients, Acta Orthopaed., 84, 380–386, https://doi.org/10.3109/17453674.2013.823589, 2013.
Kunutsor, S. K., Beswick, A. D., Whitehouse, M. R., Wylde, V., and Blom, A. W.: Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes, J. Infect., 77, 479–488, https://doi.org/10.1016/j.jinf.2018.08.017, 2018.
Kurtz, S., Ong, K., Lau, E., Mowat, F., and Halpern, M.: Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030, J. Bone Joint Surg., 89, 780–785, https://doi.org/10.2106/jbjs.F.00222, 2007.
Kurtz, S. M., Ong, K. L., Lau, E., Bozic, K. J., Berry, D., and Parvizi, J.: Prosthetic joint infection risk after TKA in the Medicare population, Clin. Orthopaed. Relat. Res., 468, 52–56, https://doi.org/10.1007/s11999-009-1013-5, 2010.
Kurtz, S. M., Lau, E. C., Son, M. S., Chang, E. T., Zimmerli, W., and Parvizi, J.: Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population, J. Arthroplast., 33, 3238–3245, https://doi.org/10.1016/j.arth.2018.05.042, 2018.
Kusejko, K., Auñón, Á., Jost, B., Natividad, B., Strahm, C., Thurnheer, C., Pablo-Marcos, D., Slama, D., Scanferla, G., Uckay, I., Waldmann, I., Esteban, J., Lora-Tamayo, J., Clauss, M., Fernandez-Sampedro, M., Wouthuyzen-Bakker, M., Ferrari, M. C., Gassmann, N., Sendi, P., Jent, P., Morand, P. C., Vijayvargiya, P., Trebše, R., Patel, R., Kouyos, R. D., Corvec, S., Kramer, T. S., Stadelmann, V. A., and Achermann, Y.: The Impact of Surgical Strategy and Rifampin on Treatment Outcome in Cutibacterium Periprosthetic Joint Infections, Clin. Infect. Dis., 72, e1064–e1073, https://doi.org/10.1093/cid/ciaa1839, 2021.
Lavernia, C. J., Guzman, J. F., and Gachupin-Garcia, A.: Cost effectiveness and quality of life in knee arthroplasty, Clin. Orthopaed. Relat. Res., 345, 134–139, 1997.
Learmonth, I. D., Young, C., and Rorabeck, C.: The operation of the century: total hip replacement, Lancet, 370, 1508–1519, https://doi.org/10.1016/s0140-6736(07)60457-7, 2007.
Lebeaux, D., Ghigo, J. M., and Beloin, C.: Biofilm-related infections: bridging the gap between clinical management and fundamental aspects of recalcitrance toward antibiotics, Microbiol. Molec. Biolo. Rev., 78, 510–543, https://doi.org/10.1128/mmbr.00013-14, 2014.
Li, H. K., Rombach, I., Zambellas, R., Walker, A. S., McNally, M. A., Atkins, B. L., Lipsky, B. A., Hughes, H. C., Bose, D., Kümin, M., Scarborough, C., Matthews, P. C., Brent, A. J., Lomas, J., Gundle, R., Rogers, M., Taylor, A., Angus, B., Byren, I., Berendt, A. R., Warren, S., Fitzgerald, F. E., Mack, D. J. F., Hopkins, S., Folb, J., Reynolds, H. E., Moore, E., Marshall, J., Jenkins, N., Moran, C. E., Woodhouse, A. F., Stafford, S., Seaton, R. A., Vallance, C., Hemsley, C. J., Bisnauthsing, K., Sandoe, J. A. T., Aggarwal, I., Ellis, S. C., Bunn, D. J., Sutherland, R. K., Barlow, G., Cooper, C., Geue, C., McMeekin, N., Briggs, A. H., Sendi, P., Khatamzas, E., Wangrangsimakul, T., Wong, T. H. N., Barrett, L. K., Alvand, A., Old, C. F., Bostock, J., Paul, J., Cooke, G., Thwaites, G. E., Bejon, P., and Scarborough, M.: Oral versus Intravenous Antibiotics for Bone and Joint Infection, N. Engl. J. Med., 380, 425–436, https://doi.org/10.1056/NEJMoa1710926, 2019.
Lora-Tamayo, J., Murillo, O., Iribarren, J. A., Soriano, A., Sánchez-Somolinos, M., Baraia-Etxaburu, J. M., Rico, A., Palomino, J., Rodríguez-Pardo, D., Horcajada, J. P., Benito, N., Bahamonde, A., Granados, A., del Toro, M. D., Cobo, J., Riera, M., Ramos, A., Jover-Sáenz, A., and Ariza, J.: A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention, Clin. Infect. Dis., 56, 182–194, https://doi.org/10.1093/cid/cis746, 2013.
Lora-Tamayo, J., Euba, G., Cobo, J., Horcajada, J. P., Soriano, A., Sandoval, E., Pigrau, C., Benito, N., Falgueras, L., Palomino, J., Del Toro, M. D., Jover-Sáenz, A., Iribarren, J. A., Sánchez-Somolinos, M., Ramos, A., Fernández-Sampedro, M., Riera, M., Baraia-Etxaburu, J. M., and Ariza, J.: Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial, Int. J. Antimicrob. Agents, 48, 310–316, https://doi.org/10.1016/j.ijantimicag.2016.05.021, 2016.
Lora-Tamayo, J., Senneville, É., Ribera, A., Bernard, L., Dupon, M., Zeller, V., Li, H. K., Arvieux, C., Clauss, M., Uçkay, I., Vigante, D., Ferry, T., Iribarren, J. A., Peel, T. N., Sendi, P., Miksic, N. G., Rodríguez-Pardo, D., Del Toro, M. D., Fernández-Sampedro, M., Dapunt, U., Huotari, K., Davis, J. S., Palomino, J., Neut, D., Clark, B. M., Gottlieb, T., Trebše, R., Soriano, A., Bahamonde, A., Guío, L., Rico, A., Salles, M. J. C., Pais, M. J. G., Benito, N., Riera, M., Gómez, L., Aboltins, C. A., Esteban, J., Horcajada, J. P., O'Connell, K., Ferrari, M., Skaliczki, G., Juan, R. S., Cobo, J., Sánchez-Somolinos, M., Ramos, A., Giannitsioti, E., Jover-Sáenz, A., Baraia-Etxaburu, J. M., Barbero, J. M., Choong, P. F. M., Asseray, N., Ansart, S., Moal, G. L., Zimmerli, W., and Ariza, J.: The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study, Clin. Infect. Dis., 64, 1742–1752, https://doi.org/10.1093/cid/cix227, 2017.
Löwik, C. A. M., Wagenaar, F. C., van der Weegen, W., Poolman, R. W., Nelissen, R., Bulstra, S. K., Pronk, Y., Vermeulen, K. M., Wouthuyzen-Bakker, M., van den Akker-Scheek, I., Stevens, M., and Jutte, P. C.: LEAK study: design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty, BMJ Open, 7, e018673, https://doi.org/10.1136/bmjopen-2017-018673, 2017.
Löwik, C. A. M., Jutte, P. C., Tornero, E., Ploegmakers, J. J. W., Knobben, B. A. S., de Vries, A. J., Zijlstra, W. P., Dijkstra, B., Soriano, A., and Wouthuyzen-Bakker, M.: Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score, J. Arthroplast., 33, 2582–2587, https://doi.org/10.1016/j.arth.2018.03.041, 2018.
Löwik, C. A. M., Parvizi, J., Jutte, P. C., Zijlstra, W. P., Knobben, B. A. S., Xu, C., Goswami, K., Belden, K. A., Sousa, R., Carvalho, A., Martínez-Pastor, J. C., Soriano, A., and Wouthuyzen-Bakker, M.: Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty, Clin. Infect. Dis., 71, 630–636, https://doi.org/10.1093/cid/ciz867, 2020.
Ludwick, L., Siqueira, M., Shohat, N., Sherman, M. B., Streicher, S., and Parvizi, J.: For Patients With Acute PJI Treated With Debridement, Antibiotics, and Implant Retention, What Factors Are Associated With Systemic Sepsis and Recurrent or Persistent Infection in Septic Patients?, Clin. Orthopaed. Relat. Res., 480, 1491–1500, https://doi.org/10.1097/corr.0000000000002192, 2022.
Marculescu, C. E., Berbari, E. F., Hanssen, A. D., Steckelberg, J. M., Harmsen, S. W., Mandrekar, J. N., and Osmon, D. R.: Outcome of prosthetic joint infections treated with debridement and retention of components, Clin. Infect. Dis., 42, 471–478, https://doi.org/10.1086/499234, 2006.
Martínez-Pastor, J. C., Muñoz-Mahamud, E., Vilchez, F., García-Ramiro, S., Bori, G., Sierra, J., Martínez, J. A., Font, L., Mensa, J., and Soriano, A.: Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis, Antimicrob. Agents Chemother., 53, 4772–4777, https://doi.org/10.1128/aac.00188-09, 2009.
McCallin, S., Drulis-Kawa, Z., Ferry, T., Pirnay, J. P., and Nir-Paz, R.: Phages and phage-borne enzymes as new antibacterial agents, Clin. Microbiol. Infec., https://doi.org/10.1016/j.cmi.2023.10.018, in press, 2023.
McPherson, E. J., Jennings, J. A., Yunis, O., Harris, M. A., Dipane, M. V., Curtin, N. L., Chowdhry, M., Wassef, A. J., Bumgardner, J. D., and Noel, S. P.: Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads, J. Bone Joint Infect., 7, 117–125, https://doi.org/10.5194/jbji-7-117-2022, 2022.
Mu, W., Xu, B., Guo, W., Ji, B., Wahafu, T., and Cao, L.: Outcome of Irrigation and Debridement With Topical Antibiotics Delivery for the Management of Periprosthetic Joint Infection Occurring Within 3 Months Since the Primary Total Joint Arthroplasty, J. Arthroplast., 36, 1765–1771, https://doi.org/10.1016/j.arth.2020.11.033, 2021.
Mulazimoglu, L., Drenning, S. D., and Muder, R. R.: Vancomycin-gentamicin synergism revisited: effect of gentamicin susceptibility of methicillin-resistant Staphylococcus aureus, Antimicrob. Agents Chemother., 40, 1534–1535, https://doi.org/10.1128/aac.40.6.1534, 1996.
Niki, Y., Matsumoto, H., Otani, T., Tomatsu, T., and Toyama, Y.: How much sterile saline should be used for efficient lavage during total knee arthroplasty? Effects of pulse lavage irrigation on removal of bone and cement debris, J. Arthroplast., 22, 95–99, https://doi.org/10.1016/j.arth.2006.02.078, 2007.
Nurmohamed, F., van Dijk, B., Veltman, E. S., Hoekstra, M., Rentenaar, R. J., Weinans, H. H., Vogely, H. C., and van der Wal, B. C. H.: One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty – a retrospective cohort study, J. Bone Joint Infect., 6, 91–97, https://doi.org/10.5194/jbji-6-91-2021, 2021.
Okae, Y., Nishitani, K., Sakamoto, A., Kawai, T., Tomizawa, T., Saito, M., Kuroda, Y., and Matsuda, S.: Estimation of Minimum Biofilm Eradication Concentration (MBEC) on In Vivo Biofilm on Orthopedic Implants in a Rodent Femoral Infection Model, Front. Cell. Infect. Microbiol., 12, 896978, https://doi.org/10.3389/fcimb.2022.896978, 2022.
Ong, K. L., Kurtz, S. M., Lau, E., Bozic, K. J., Berry, D. J., and Parvizi, J.: Prosthetic joint infection risk after total hip arthroplasty in the Medicare population, J. Arthroplast., 24, 105–109, https://doi.org/10.1016/j.arth.2009.04.027, 2009.
Osmon, D. R., Berbari, E. F., Berendt, A. R., Lew, D., Zimmerli, W., Steckelberg, J. M., Rao, N., Hanssen, A., and Wilson, W. R.: Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America, Clin. Infect. Dis., 56, e1–e25, https://doi.org/10.1093/cid/cis803, 2013.
Ottesen, C. S., Troelsen, A., Sandholdt, H., Jacobsen, S., Husted, H., and Gromov, K.: Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement, Antibiotics, and Implant Retention, J. Arthroplast., 34, 365–368, https://doi.org/10.1016/j.arth.2018.09.088, 2019.
Patel, V. P., Walsh, M., Sehgal, B., Preston, C., DeWal, H., and Di Cesare, P. E.: Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty, J. Bone Joint Surg., 89, 33–38, https://doi.org/10.2106/jbjs.F.00163, 2007.
Perez, B. A., Koressel, J. E., Lopez, V. S., Barchick, S., Pirruccio, K., and Lee, G. C.: Does a 2-Stage Debridement Result in Higher Rates of Implant Retention Compared With Single Debridement Alone?, J. Arthroplast., 37, 669–673, https://doi.org/10.1016/j.arth.2022.02.040, 2022.
Piovan, G., Farinelli, L., Screpis, D., Marocco, S., Motta, L., Palazzolo, G., Natali, S., and Zorzi, C.: The role of antibiotic calcium sulfate beads in acute periprosthetic knee infection: a retrospective cohort study, Arthroplasty, 4, 42, https://doi.org/10.1186/s42836-022-00139-2, 2022.
Puhto, T., Puhto, A. P., Vielma, M., and Syrjälä, H.: Infection triples the cost of a primary joint arthroplasty, Infect. Dis., 51, 348–355, https://doi.org/10.1080/23744235.2019.1572219, 2019.
Qu, G. X., Zhang, C. H., Yan, S. G., and Cai, X. Z.: Debridement, antibiotics, and implant retention for periprosthetic knee infections: a pooling analysis of 1266 cases, J. Orthopesd. Surg. Res., 14, 358, https://doi.org/10.1186/s13018-019-1378-4, 2019.
Rahardja, R., Zhu, M., Davis, J. S., Manning, L., Metcalf, S., and Young, S. W.: Success of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infection Following Primary Total Knee Arthroplasty: Results From a Prospective Multicenter Study of 189 Cases, J. Arthroplast., 38, 399–404, https://doi.org/10.1016/j.arth.2023.04.024, 2023.
Rakow, A., Perka, C., Trampuz, A., and Renz, N.: Origin and characteristics of haematogenous periprosthetic joint infection, Clin. Microbiol. Infect., 25, 845–850, https://doi.org/10.1016/j.cmi.2018.10.010, 2019.
Reinisch, K., Schläppi, M., Meier, C., and Wahl, P.: Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty – a retrospective study, J. Bone Joint Infect., 7, 11–21, https://doi.org/10.5194/jbji-7-11-2022, 2022.
Rodríguez-Pardo, D., Pigrau, C., Lora-Tamayo, J., Soriano, A., del Toro, M. D., Cobo, J., Palomino, J., Euba, G., Riera, M., Sánchez-Somolinos, M., Benito, N., Fernández-Sampedro, M., Sorli, L., Guio, L., Iribarren, J. A., Baraia-Etxaburu, J. M., Ramos, A., Bahamonde, A., Flores-Sánchez, X., Corona, P. S., and Ariza, J.: Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study, Clin. Microbiol. Infect., 20, 911–919, https://doi.org/10.1111/1469-0691.12649, 2014.
Saleh, K., Olson, M., Resig, S., Bershadsky, B., Kuskowski, M., Gioe, T., Robinson, H., Schmidt, R., and McElfresh, E.: Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program, J. Orthopaed. Res., 20, 506–515, https://doi.org/10.1016/s0736-0266(01)00153-x, 2002.
Sanicola, S. M. and Albert, S. F.: The in vitro elution characteristics of vancomycin and tobramycin from calcium sulfate beads, J. Foot Ankle Surg., 44, 121–124, https://doi.org/10.1053/j.jfas.2005.01.006, 2005.
Scheper, H. and De Boer, M. G. J.: Rifampin for Staphylococcal Prosthetic Joint Infection: Do We Still Need a Randomized Controlled Trial?, Clin. Infect. Dis., 74, 1316–1318, https://doi.org/10.1093/cid/ciab704, 2022.
Scheper, H., Gerritsen, L. M., Pijls, B. G., Van Asten, S. A., Visser, L. G., and De Boer, M. G. J.: Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis, Open Forum Infect. Dis., 8, ofab298, https://doi.org/10.1093/ofid/ofab298, 2021.
Scheper, H., Mahdad, R., Elzer, B., Löwik, C., Zijlstra, W., Gosens, T., van der Lugt, J. C. T., van der Wal, R. J. P., Poolman, R. W., Somford, M. P., Jutte, P. C., Bos, P. K., Zwaan, R. E., Nelissen, R., Visser, L. G., de Boer, M. G. J., and the wound care app study group: Wound drainage after arthroplasty and prediction of acute prosthetic joint infection: prospective data from a multicentre cohort study using a telemonitoring app, J. Bone Joint Infect., 8, 59–70, https://doi.org/10.5194/jbji-8-59-2023, 2023.
Schwartz, A. M., Farley, K. X., Guild, G. N., and Bradbury Jr., T. L.: Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030, J. Arthroplast., 35, 79–85, https://doi.org/10.1016/j.arth.2020.02.030, 2020.
Sendi, P., Lötscher, P. O., Kessler, B., Graber, P., Zimmerli, W., and Clauss, M.: Debridement and implant retention in the management of hip periprosthetic joint infection: outcomes following guided and rapid treatment at a single centre, Bone Joint J., 99b, 330–336, https://doi.org/10.1302/0301-620x.99b3.Bjj-2016-0609.R1, 2017.
Shahi, A., Tan, T. L., Chen, A. F., Maltenfort, M. G., and Parvizi, J.: In-Hospital Mortality in Patients With Periprosthetic Joint Infection, J. Arthroplast., 32, 948–952, https://doi.org/10.1016/j.arth.2016.09.027, 2017.
Shapiro, N. I., Wolfe, R. E., Wright, S. B., Moore, R., and Bates, D. W.: Who needs a blood culture? A prospectively derived and validated prediction rule, J. Emerg. Med., 35, 255–264, https://doi.org/10.1016/j.jemermed.2008.04.001, 2008.
Shaw, J. D., Miller, S., Plourde, A., Shaw, D. L., Wustrack, R., and Hansen, E. N.: Methylene Blue-Guided Debridement as an Intraoperative Adjunct for the Surgical Treatment of Periprosthetic Joint Infection, J. Arthroplast., 32, 3718–3723, https://doi.org/10.1016/j.arth.2017.07.019, 2017.
Sherrell, J. C., Fehring, T. K., Odum, S., Hansen, E., Zmistowski, B., Dennos, A., and Kalore, N.: The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and débridement for periprosthetic knee infection, Clin. Orthopaed. Relat. Res., 469, 18–25, https://doi.org/10.1007/s11999-010-1434-1, 2011.
Shohat, N., Goswami, K., Tan, T. L., Yayac, M., Soriano, A., Sousa, R., Wouthuyzen-Bakker, M., and Parvizi, J.: 2020 Frank Stinchfield Award: Identifying who will fail following irrigation and debridement for prosthetic joint infection, Bone Joint J., 102b, 11–19, https://doi.org/10.1302/0301-620x.102b7.Bjj-2019-1628.R1, 2020.
Siddiqi, A., Abdo, Z. E., Rossman, S. R., Kelly, M. A., Piuzzi, N. S., Higuera, C. A., Schwarzkopf, R., Springer, B. D., Chen, A. F., and Parvizi, J.: What Is the Optimal Irrigation Solution in the Management of Periprosthetic Hip and Knee Joint Infections?, J. Arthroplast., 36, 3570–3583, https://doi.org/10.1016/j.arth.2021.05.032, 2021.
Sigmund, I. K. and McNally, M.: Diagnosis of bone and joint infections, Orthopead. Trauma, 33, 144–152, https://doi.org/10.1016/j.mporth.2019.03.001, 2019.
Sigmund, I. K., Yeghiazaryan, L., Luger, M., Windhager, R., Sulzbacher, I., and McNally, M. A.: Three to six tissue specimens for histopathological analysis are most accurate for diagnosing periprosthetic joint infection, Bone Joint J., 105b, 158–165, https://doi.org/10.1302/0301-620x.105b2.Bjj-2022-0859.R1, 2023.
Sigmund, I. K., Palmer, A. J. R., Hotchen, A. J., McNally, M. A., Young, B. C., Alvand, A., Taylor, A., and Kendrick, B. J. L.: The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome, Acta Orthopaed., 95, 707–714, https://doi.org/10.2340/17453674.2024.42360, 2024.
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J. L., and Angus, D. C.: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), J. Am. Med. Assoc., 315, 801–810, https://doi.org/10.1001/jama.2016.0287, 2016.
Singh, J. A., Yu, S., Chen, L., and Cleveland, J. D.: Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample, J. Rheumatol., 46, 1134–1140, https://doi.org/10.3899/jrheum.170990, 2019.
Smith, K., Perez, A., Ramage, G., Gemmell, C. G., and Lang, S.: Comparison of biofilm-associated cell survival following in vitro exposure of meticillin-resistant Staphylococcus aureus biofilms to the antibiotics clindamycin, daptomycin, linezolid, tigecycline and vancomycin, Int. J. Antimicrob. Agents, 33, 374–378, https://doi.org/10.1016/j.ijantimicag.2008.08.029, 2009.
Sousa, A., Carvalho, A., Pereira, C., Reis, E., Santos, A. C., Abreu, M., Soares, D., Fragoso, R., Ferreira, S., Reis, M., and Sousa, R.: Economic Impact of Prosthetic Joint Infection – an Evaluation Within the Portuguese National Health System, J. Bone Joint Infect., 3, 197–202, https://doi.org/10.7150/jbji.28508, 2018.
Sousa, R., Ribau, A., Alfaro, P., Burch, M. A., Ploegmakers, J., McNally, M., Clauss, M., Wouthuyzen-Bakker, M., and Soriano, A.: The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions, Acta Orthopaed., 94, 8–18, https://doi.org/10.2340/17453674.2023.5670, 2023.
Steadman, W., Chapman, P. R., Schuetz, M., Schmutz, B., Trampuz, A., and Tetsworth, K.: Local Antibiotic Delivery Options in Prosthetic Joint Infection, Antibiotics, 12, 752, https://doi.org/10.3390/antibiotics12040752, 2023.
Sukhonthamarn, K., Tan, T. L., Strony, J., Brown, S., Nazarian, D., and Parvizi, J.: The Fate of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction, JBJS Open Access, 6, e21.00003, https://doi.org/10.2106/jbjs.Oa.21.00003, 2021.
Svensson, K., Rolfson, O., Nauclér, E., Lazarinis, S., Sköldenberg, O., Schilcher, J., Johanson, P. E., Mohaddes, M., and Kärrholm, J.: Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention: An Observational Study of 575 Patients with Infection After Primary Total Hip Arthroplasty, JBJS Open Access, 5, e20.00110, https://doi.org/10.2106/jbjs.Oa.20.00110, 2020.
Swenson, R. D., Butterfield, J. A., Irwin, T. J., Zurlo, J. J., and Davis III, C. M.: Preoperative Anemia Is Associated With Failure of Open Debridement Polyethylene Exchange in Acute and Acute Hematogenous Prosthetic Joint Infection, J. Arthroplast., 33, 1855–1860, https://doi.org/10.1016/j.arth.2018.01.042, 2018.
Tai, D. B. G., Berbari, E. F., Suh, G. A., Lahr, B. D., Abdel, M. P., and Tande, A. J.: Truth in DAIR: Duration of Therapy and the Use of Quinolone/Rifampin-Based Regimens After Debridement and Implant Retention for Periprosthetic Joint Infections, Open Forum Infect. Dis., 9, ofac363, https://doi.org/10.1093/ofid/ofac363, 2022.
Tarar, M. Y., Khalid, A., Usman, M., Javed, K., Shah, N., and Abbas, M. W.: Wound Leakage With the Use of Calcium Sulphate Beads in Prosthetic Joint Surgeries: A Systematic Review, Cureus, 13, e19650, https://doi.org/10.7759/cureus.19650, 2021.
Tarity, T. D., Gkiatas, I., Nocon, A. A., Jones, C. W., Carli, A. V., and Sculco, P. K.: Irrigation and Debridement With Implant Retention: Does Chronicity of Symptoms Matter?, J. Arthroplast., 36, 3741–3749, https://doi.org/10.1016/j.arth.2021.07.018, 2021.
Tarity, T. D., Xiang, W., Jones, C. W., Gkiatas, I., Nocon, A., Selemon, N. A., Carli, A., and Sculco, P. K.: Do Antibiotic-Loaded Calcium Sulfate Beads Improve Outcomes After Debridement, Antibiotics, and Implant Retention? A Matched Cohort Study, Arthroplast. Today, 14, 90–95, https://doi.org/10.1016/j.artd.2022.01.023, 2022.
Thwaites, J. H., Thwaites, J. F., Ted, K. L. Y., and Chuang, T.: Symptomatic hypercalcaemia following the use of calcium sulfate beads in periprosthetic joint infections, New Zeal. Med. J., 135, 124–126, 2022.
Tirumala, V., Smith, E., Box, H., van den Kieboom, J., Klemt, C., and Kwon, Y. M.: Outcome of Debridement, Antibiotics, and Implant Retention With Modular Component Exchange in Acute Culture-Negative Periprosthetic Joint Infections, J. Arthroplast., 36, 1087–1093, https://doi.org/10.1016/j.arth.2020.08.065, 2021.
Toh, R. X., Yeo, Z. N., Liow, M. H. L., Yeo, S. J., Lo, N. N., and Chen, J. Y.: Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection: What Predicts Success or Failure?, J. Arthroplast., 36, 3562–3569, https://doi.org/10.1016/j.arth.2021.05.023, 2021.
Tornero, E., Morata, L., Martínez-Pastor, J. C., Bori, G., Climent, C., García-Velez, D. M., García-Ramiro, S., Bosch, J., Mensa, J., and oriano, A.: KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics, Clin. Microbiol. Infect., 21, 786.e9–786e17, https://doi.org/10.1016/j.cmi.2015.04.012, 2015.
Tornero, E., Morata, L., Martínez-Pastor, J. C., Angulo, S., Combalia, A., Bori, G., García-Ramiro, S., Bosch, J., Mensa, J., and Soriano, A.: Importance of selection and duration of antibiotic regimen in prosthetic joint infections treated with debridement and implant retention, J. Antimicrob. Chemother., 71, 1395–1401, https://doi.org/10.1093/jac/dkv481, 2016.
Triantafyllopoulos, G. K., Poultsides, L. A., Zhang, W., Sculco, P. K., Ma, Y., and Sculco, T. P.: Periprosthetic knee infections treated with irrigation and debridement: outcomes and preoperative predictive factors, J. Arthroplast., 30, 649–657, https://doi.org/10.1016/j.arth.2014.10.026, 2015.
Triantafyllopoulos, G., Poultsides, L. A., Zhang, W., Sculco, P. K., Ma, Y., and Sculco, T. P.: Multiple Irrigation and Debridements for Periprosthetic Joint Infections: Facing a Necessity or Just Prolonging the Inevitable?, J. Arthroplast., 31, 219–224, https://doi.org/10.1016/j.arth.2015.06.051, 2016.
Tsang, S. J., Ting, J., Simpson, A., and Gaston, P.: Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies, Bone Joint J., 99b, 1458–1466, https://doi.org/10.1302/0301-620x.99b11.Bjj-2017-0088.R1, 2017.
Urish, K. L., DeMuth, P. W., Craft, D. W., Haider, H., and Davis III, C. M.: Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials, J. Arthroplast., 29, 1128–1132, https://doi.org/10.1016/j.arth.2013.12.012, 2014.
Urish, K. L., Bullock, A. G., Kreger, A. M., Shah, N. B., Jeong, K., and Rothenberger, S. D.: A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High, J. Arthroplast., 33, 1154–1159, https://doi.org/10.1016/j.arth.2017.11.029, 2018.
Vanhegan, I. S., Malik, A. K., Jayakumar, P., Ul Islam, S., and Haddad, F. S.: A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff, J. Bone Joint Surg., 94, 619–623, https://doi.org/10.1302/0301-620x.94b5.27073, 2012.
Veerman, C. M., Goosen, J. H. M., Telgt, D. S. C., Rijnen, W. H. M., Nabuurs, M. H., and Wertheim, H. F. L.: Assessment of antimicrobial mismatches in empirical treatment in early PJI after aseptic revision arthroplasty, JAC Antimicrob. Resist., 4, dlac124, https://doi.org/10.1093/jacamr/dlac124, 2022a.
Veerman, K., Raessens, J., Telgt, D., Smulders, K., and Goosen, J. H. M.: Debridement, antibiotics, and implant retention after revision arthroplasty: antibiotic mismatch, timing, and repeated DAIR associated with poor outcome, Bone Joint J., 104b, 464–471, https://doi.org/10.1302/0301-620x.104b4.Bjj-2021-1264.R1, 2022b.
Wouthuyzen-Bakker, M., Sebillotte, M., Lomas, J., Taylor, A., Palomares, E. B., Murillo, O., Parvizi, J., Shohat, N., Reinoso, J. C., Sánchez, R. E., Fernandez-Sampedro, M., Senneville, E., Huotari, K., Barbero, J. M., Garcia-Cañete, J., Lora-Tamayo, J., Ferrari, M. C., Vaznaisiene, D., Yusuf, E., Aboltins, C., Trebse, R., Salles, M. J., Benito, N., Vila, A., Toro, M. D. D., Kramer, T. S., Petersdorf, S., Diaz-Brito, V., Tufan, Z. K., Sanchez, M., Arvieux, C., and Soriano, A.: Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention, J. Infect., 78, 40–47, https://doi.org/10.1016/j.jinf.2018.07.014, 2019.
Wouthuyzen-Bakker, M., Löwik, C. A. M., Ploegmakers, J. J. W., Knobben, B. A. S., Dijkstra, B., de Vries, A. J., Mithoe, G., Kampinga, G., Zijlstra, W. P., and Jutte, P. C.: A Second Surgical Debridement for Acute Periprosthetic Joint Infections Should Not Be Discarded, J. Arthroplast., 35, 2204–2209, https://doi.org/10.1016/j.arth.2020.02.043, 2020a.
Wouthuyzen-Bakker, M., Sebillotte, M., Huotari, K., Escudero Sánchez, R., Benavent, E., Parvizi, J., Fernandez-Sampedro, M., Barbero, J. M., Garcia-Cañete, J., Trebse, R., Del Toro, M., Diaz-Brito, V., Sanchez, M., Scarborough, M., and Soriano, A.: Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study, Clin. Orthopaed. Relat. Res., 478, 1348–1355, https://doi.org/10.1097/corr.0000000000001171, 2020b.
Wouthuyzen-Bakker, M., Shohat, N., Parvizi, J., and Soriano, A.: Risk Scores and Machine Learning to Identify Patients With Acute Periprosthetic Joints Infections That Will Likely Fail Classical Irrigation and Debridement, Front. Med., 8, 550095, https://doi.org/10.3389/fmed.2021.550095, 2021.
Yassien, M., Khardori, N., Ahmedy, A., and Toama, M.: Modulation of biofilms of Pseudomonas aeruginosa by quinolones, Antimicrob. Agents Chemother., 39, 2262–2268, https://doi.org/10.1128/aac.39.10.2262, 1995.
Zhang, C. F., He, L., Fang, X. Y., Huang, Z. D., Bai, G. C., Li, W. B., and Zhang, W. M.: Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection, Orthopaed. Surg., 12, 463–470, https://doi.org/10.1111/os.12641, 2020.
Zhu, M. F., Kim, K., Cavadino, A., Coleman, B., Munro, J. T., and Young, S. W.: Success Rates of Debridement, Antibiotics, and Implant Retention in 230 Infected Total Knee Arthroplasties: Implications for Classification of Periprosthetic Joint Infection, J. Arthroplast., 36, 305–310, https://doi.org/10.1016/j.arth.2020.07.081, 2021.
Zimmerli, W., Widmer, A. F., Blatter, M., Frei, R., and Ochsner, P. E.: Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group, J. Am. Med. Assoc., 279, 1537–1541, https://doi.org/10.1001/jama.279.19.1537, 1998.
Zimmerli, W., Trampuz, A., and Ochsner, P. E.: Prosthetic-joint infections, N. Engl. J. Med., 351, 1645–1654, https://doi.org/10.1056/NEJMra040181, 2004.
Zmistowski, B., Karam, J. A., Durinka, J. B., Casper, D. S., and Parvizi, J.: Periprosthetic joint infection increases the risk of one-year mortality, J. Bone Joint Surg., 95, 2177–2184, https://doi.org/10.2106/jbjs.L.00789, 2013.
Zmistowski, B. M., Manrique, J., Patel, R., and Chen, A. F.: Recurrent Periprosthetic Joint Infection After Irrigation and Debridement With Component Retention Is Most Often Due to Identical Organisms, J. Arthroplast., 31, 148–151, https://doi.org/10.1016/j.arth.2016.05.040, 2016.
Short summary
In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
In this paper, we discuss the most relevant factors influencing the outcome and define...
