The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome
Background and purpose: We aimed to compare the effect of calcium sulphate (CS) beads loaded with antibiotics on infection eradication in debridement, antibiotics, and implant retention (DAIR) of periprosthetic joint infection relative to DAIR without local antibiotics delivery. Methods: 176 patien...
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Medical Journals Sweden
2024-11-01
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| Series: | Acta Orthopaedica |
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| Online Access: | https://actaorthop.org/actao/article/view/42360 |
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| author | Irene Katharina Sigmund Antony J R Palmer Andrew J Hotchen Martin A McNally Bernadette C Young Abtin Alvand Adrian Taylor Benjamin John Lee Kendrick |
| author_facet | Irene Katharina Sigmund Antony J R Palmer Andrew J Hotchen Martin A McNally Bernadette C Young Abtin Alvand Adrian Taylor Benjamin John Lee Kendrick |
| author_sort | Irene Katharina Sigmund |
| collection | DOAJ |
| description |
Background and purpose: We aimed to compare the effect of calcium sulphate (CS) beads loaded with antibiotics on infection eradication in debridement, antibiotics, and implant retention (DAIR) of periprosthetic joint infection relative to DAIR without local antibiotics delivery.
Methods: 176 patients with hip or knee arthroplasty undergoing DAIR were retrospectively identified and divided into a bead group (n = 102) and a control group (n = 74). Infections were classified as early postoperative, acute hematogenous, and chronic. Logistic regression analyses were performed on the use of CS beads. Revision-free and infection-free survival was estimated using Kaplan–Meier analysis.
Results: Reinfection occurred in 36% of the bead group, and 39% of the control group (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.5– 1.6); reoperation rates were 34% and 43% (OR 0.7, CI 0.4–1.3). Kaplan–Meier analysis showed no statistically significant difference between the 2 groups regarding infection-free (HR 1.1, CI 0.7–1.8) and revision-free (HR 1.1, CI 0.7–1.9) survival rates. In acute hematogenous PJIs, reinfection (29% vs 56%, OR 0.3, CI 0.1–1.1) and reoperation rates (25% vs 61%, OR 0.2, CI 0.1–0.8) were reduced when CS beads were used; Kaplan–Meier analysis revealed higher infection-free (HR 0.5, CI 0.2–1.4) and revision-free (HR 0.5, CI 0.2–1.3) survival rates in the bead group but not of statistical significance. Wound drainage was not increased by CS beads use (OR 1.0, CI 0.99–1.01), but hypercalcemia was seen in 9% in the bead group.
Conclusion: DAIR with antibiotic-loaded CS beads did not improve outcome in early postoperative and chronic PJIs, but reduced the reoperation rate in acute haematogenous infections with similar results compared with early postoperative PJIs.
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| format | Article |
| id | doaj-art-d7344e4468d640118e3d1bf7a09fb8b4 |
| institution | OA Journals |
| issn | 1745-3674 1745-3682 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Medical Journals Sweden |
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| series | Acta Orthopaedica |
| spelling | doaj-art-d7344e4468d640118e3d1bf7a09fb8b42025-08-20T01:54:23ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822024-11-019510.2340/17453674.2024.42360The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcomeIrene Katharina Sigmund0Antony J R Palmer1Andrew J Hotchen2Martin A McNally3https://orcid.org/0000-0003-2003-9044Bernadette C Young4Abtin Alvand5Adrian Taylor6Benjamin John Lee Kendrick7Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK; Department of Orthopaedics, Medical University of Vienna, Vienna, AustriaNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford; Nuffield Department of Medicine, University of Oxford, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UKNuffield Orthopaedic Centre, Oxford University Hospitals, Oxford; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK Background and purpose: We aimed to compare the effect of calcium sulphate (CS) beads loaded with antibiotics on infection eradication in debridement, antibiotics, and implant retention (DAIR) of periprosthetic joint infection relative to DAIR without local antibiotics delivery. Methods: 176 patients with hip or knee arthroplasty undergoing DAIR were retrospectively identified and divided into a bead group (n = 102) and a control group (n = 74). Infections were classified as early postoperative, acute hematogenous, and chronic. Logistic regression analyses were performed on the use of CS beads. Revision-free and infection-free survival was estimated using Kaplan–Meier analysis. Results: Reinfection occurred in 36% of the bead group, and 39% of the control group (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.5– 1.6); reoperation rates were 34% and 43% (OR 0.7, CI 0.4–1.3). Kaplan–Meier analysis showed no statistically significant difference between the 2 groups regarding infection-free (HR 1.1, CI 0.7–1.8) and revision-free (HR 1.1, CI 0.7–1.9) survival rates. In acute hematogenous PJIs, reinfection (29% vs 56%, OR 0.3, CI 0.1–1.1) and reoperation rates (25% vs 61%, OR 0.2, CI 0.1–0.8) were reduced when CS beads were used; Kaplan–Meier analysis revealed higher infection-free (HR 0.5, CI 0.2–1.4) and revision-free (HR 0.5, CI 0.2–1.3) survival rates in the bead group but not of statistical significance. Wound drainage was not increased by CS beads use (OR 1.0, CI 0.99–1.01), but hypercalcemia was seen in 9% in the bead group. Conclusion: DAIR with antibiotic-loaded CS beads did not improve outcome in early postoperative and chronic PJIs, but reduced the reoperation rate in acute haematogenous infections with similar results compared with early postoperative PJIs. https://actaorthop.org/actao/article/view/42360Calcium sulphateCalcium sulphate beadsDAIRDebridement, antibiotics, and implant retentionLocal antibiotics |
| spellingShingle | Irene Katharina Sigmund Antony J R Palmer Andrew J Hotchen Martin A McNally Bernadette C Young Abtin Alvand Adrian Taylor Benjamin John Lee Kendrick 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 Orthopaedica Calcium sulphate Calcium sulphate beads DAIR Debridement, antibiotics, and implant retention Local antibiotics |
| title | The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome |
| title_full | The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome |
| title_fullStr | The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome |
| title_full_unstemmed | The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome |
| title_short | The use of antibiotic-loaded calcium sulphate beads in debridement, antibiotics, and implant retention (DAIR) for periprosthetic infections: a retrospective comparative cohort on outcome |
| title_sort | use of antibiotic loaded calcium sulphate beads in debridement antibiotics and implant retention dair for periprosthetic infections a retrospective comparative cohort on outcome |
| topic | Calcium sulphate Calcium sulphate beads DAIR Debridement, antibiotics, and implant retention Local antibiotics |
| url | https://actaorthop.org/actao/article/view/42360 |
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