Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review
Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining momentum as surgical option in end-stage ankle osteoarthritis. Periprosthetic joint infection (PJI) is one of the most common complications and its management may be challenging. Our aim was to define the...
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SAGE Publishing
2024-12-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011424S00230 |
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| author | Antonio Izzo MD Claudia Carbone MD Enrico Festa MD Giovanni Balato MD, PhD Massimo Mariconda MD François Lintz MD, PhD Alessio Bernasconi MD, PhD |
| author_facet | Antonio Izzo MD Claudia Carbone MD Enrico Festa MD Giovanni Balato MD, PhD Massimo Mariconda MD François Lintz MD, PhD Alessio Bernasconi MD, PhD |
| author_sort | Antonio Izzo MD |
| collection | DOAJ |
| description | Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining momentum as surgical option in end-stage ankle osteoarthritis. Periprosthetic joint infection (PJI) is one of the most common complications and its management may be challenging. Our aim was to define the eradication rate and limits of the surgical procedures performed to treat PJI after TAR. Methods: This systematic review followed the PRISMA checklist and was registered in the Open Science Framework platform. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria and the surgical treatment for PJI. The methodological index for nonrandomized studies (MINORS) was used to assess the methodological quality of studies. Three groups were built based on the surgical procedure performed by authors: Group 1 for debridement, antibiotics, and implant retention (DAIR), Group 2 for 1.5-stage revision (1.5-stage) and Group 3 for 2-stage revision procedures (2-stage). Results: Fourteen cohorts (eight studies,152 infected TARs, 152 patients; 44% females, mean age: 61.4 years) were included. All studies had a retrospective design. Ankle pain with swelling and increased local temperature usually led to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis with positive blood tests. Microorganisms were identified in 92% (range,64%-100%) of cases. The definition of eradication of the infection was heterogenous ( ‘no more surgery’ (4 studies)), normal clinical-serological markers (2 studies), negative intraoperative cultures (2 studies). The eradication rate in DAIR, 1.5-stage and 2-stage groups was 64% (39/58 patients) 91% (11/12) and 89% (47/54),respectively. The incidence of below-knee amputation was 6.5% at 38.6-month follow-up. MINORS score was 8/16 for noncomparative studies and 14.6/24 for comparative ones (moderate quality). Conclusion: Decision-making in PJI after TAR is based on small-sample retrospective studies of moderate quality. In this review, the estimated effectiveness of DAIR and exchange procedures to eradicate the infection was two-thirds and nine-tenths, respectively. In case of failure, below-knee amputation is not uncommon. |
| format | Article |
| id | doaj-art-5e0e8fd60086459ba47dea876825ef11 |
| institution | OA Journals |
| issn | 2473-0114 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj-art-5e0e8fd60086459ba47dea876825ef112025-08-20T01:59:52ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-12-01910.1177/2473011424S00230Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic ReviewAntonio Izzo MDClaudia Carbone MDEnrico Festa MDGiovanni Balato MD, PhDMassimo Mariconda MDFrançois Lintz MD, PhDAlessio Bernasconi MD, PhDCategory: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining momentum as surgical option in end-stage ankle osteoarthritis. Periprosthetic joint infection (PJI) is one of the most common complications and its management may be challenging. Our aim was to define the eradication rate and limits of the surgical procedures performed to treat PJI after TAR. Methods: This systematic review followed the PRISMA checklist and was registered in the Open Science Framework platform. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria and the surgical treatment for PJI. The methodological index for nonrandomized studies (MINORS) was used to assess the methodological quality of studies. Three groups were built based on the surgical procedure performed by authors: Group 1 for debridement, antibiotics, and implant retention (DAIR), Group 2 for 1.5-stage revision (1.5-stage) and Group 3 for 2-stage revision procedures (2-stage). Results: Fourteen cohorts (eight studies,152 infected TARs, 152 patients; 44% females, mean age: 61.4 years) were included. All studies had a retrospective design. Ankle pain with swelling and increased local temperature usually led to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis with positive blood tests. Microorganisms were identified in 92% (range,64%-100%) of cases. The definition of eradication of the infection was heterogenous ( ‘no more surgery’ (4 studies)), normal clinical-serological markers (2 studies), negative intraoperative cultures (2 studies). The eradication rate in DAIR, 1.5-stage and 2-stage groups was 64% (39/58 patients) 91% (11/12) and 89% (47/54),respectively. The incidence of below-knee amputation was 6.5% at 38.6-month follow-up. MINORS score was 8/16 for noncomparative studies and 14.6/24 for comparative ones (moderate quality). Conclusion: Decision-making in PJI after TAR is based on small-sample retrospective studies of moderate quality. In this review, the estimated effectiveness of DAIR and exchange procedures to eradicate the infection was two-thirds and nine-tenths, respectively. In case of failure, below-knee amputation is not uncommon.https://doi.org/10.1177/2473011424S00230 |
| spellingShingle | Antonio Izzo MD Claudia Carbone MD Enrico Festa MD Giovanni Balato MD, PhD Massimo Mariconda MD François Lintz MD, PhD Alessio Bernasconi MD, PhD Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review Foot & Ankle Orthopaedics |
| title | Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review |
| title_full | Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review |
| title_fullStr | Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review |
| title_full_unstemmed | Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review |
| title_short | Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review |
| title_sort | debridement antibiotics and implant retention dair vs 1 5 stage revision vs 2 stage revision in periprosthetic ankle joint infection a systematic review |
| url | https://doi.org/10.1177/2473011424S00230 |
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