Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis
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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2021-10-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.210.BJO-2021-0090.R1 |
| _version_ | 1819140461131988992 |
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| author | Maxime Gerritsen Abdullah Khawar Henk Scheper Robert van der Wal Jan Schoones Mark de Boer Rob Nelissen Bart Pijls |
| author_facet | Maxime Gerritsen Abdullah Khawar Henk Scheper Robert van der Wal Jan Schoones Mark de Boer Rob Nelissen Bart Pijls |
| author_sort | Maxime Gerritsen |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-22T11:38:55Z |
| format | Article |
| id | doaj.art-3bdc05b2edf14707ae6f49dd6bb11f80 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-22T11:38:55Z |
| publishDate | 2021-10-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-3bdc05b2edf14707ae6f49dd6bb11f802022-12-21T18:27:20ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622021-10-0121080681210.1302/2633-1462.210.BJO-2021-0090.R1Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysisMaxime Gerritsen0Abdullah Khawar1Henk Scheper2Robert van der Wal3Jan Schoones4Mark de Boer5Rob Nelissen6Bart Pijls7Dept. of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the NetherlandsDept. of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the NetherlandsDept of Infectious Disease, Leiden University Medical Center, Leiden, the NetherlandsDept. of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the NetherlandsDirectorate of Research Policy (formerly: Walaeus Library), Leiden University Medical Center, Leiden, the NetherlandsDept of Infectious Disease, Leiden University Medical Center, Leiden, the NetherlandsDept. of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the NetherlandsDept. of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the NetherlandsAims: 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 IIIhttps://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.210.BJO-2021-0090.R1periprosthetic joint infectiondairmodular component exchangetotal joint replacementdebridement, antibiotics, and implant retentionhipsknee periprosthetic joint infectionperiprosthetic joint infection (pji)kneesregression analysisrevision arthroplastiesrandomized controlled trialsdebridementlower limb arthroplasties |
| spellingShingle | Maxime Gerritsen Abdullah Khawar Henk Scheper Robert van der Wal Jan Schoones Mark de Boer Rob Nelissen Bart Pijls Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis Bone & Joint Open 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 |
| title | Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis |
| title_full | Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis |
| title_fullStr | Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis |
| title_full_unstemmed | Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis |
| title_short | Modular component exchange and outcome of DAIR for hip and knee periprosthetic joint infection: a systematic review and meta-regression analysis |
| title_sort | modular component exchange and outcome of dair for hip and knee periprosthetic joint infection a systematic review and meta regression analysis |
| topic | 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 |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.210.BJO-2021-0090.R1 |
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