Eradication rate after debridement, antibiotics, and implant retention (DAIR), 1.5-stage revision or 2-stage revision in periprosthetic ankle joint infection: A systematic review.

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery Pub Date : 2025-05-14 DOI:10.1016/j.fas.2025.05.006

Antonio Izzo, Claudia Carbone, Vincenzo De Matteo, François Lintz, Enrico Festa, Giovanni Balato, Alessio Bernasconi

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引用次数: 0

Abstract

Objective: The management of periprosthetic joint infection (PJI) after total ankle replacement (TAR) may be challenging. Our aim was to define the eradication rate and limits of some of the surgical procedures commonly performed to treat acute and chronic PJI after TAR.

Methods: For this PRISMA-compliant systematic review multiple databases were searched including clinical studies in which acute or chronic PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria adopted 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 in the studies: 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: Thirteen cohorts from seven studies (138 infected TARs; 40 % females, mean age 61.3 years) published between 2012 and 2023 were included. The definition of eradication of the infection was heterogenous among studies (reported as 'no more surgery' in 3 studies, normal clinical and serological markers in 2 studies and negative intraoperative cultures in 2 studies). The pooled eradication rate in DAIR, 1.5-stage and 2-stage revision groups was 89 % (95 %CI, 79-100), 95 % (95 %CI, 70-100) and 92 % (95 %CI, 80-99), respectively. The proportion of below-knee amputation was 7.2 % (10/138) at a mean 39.3-month follow-up. MINORS score (7.6/16 and 14.6/24 for noncomparative and comparative studies, respectively) revealed a poor quality of studies.

Conclusions: In this review, the estimated effectiveness of DAIR, 1.5 and 2-stage exchange procedures to eradicate PJI after TAR was 89 %, 95 % and 92 %, respectively. Decision-making in this setting is based on small-sample retrospective studies of poor quality. Below-knee amputation rate after a diagnosis of PJI was 7.2 %.

Level of evidence: Level IV, systematic review of Level IV studies.

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清创、抗生素和种植体保留（DAIR）、1.5期翻修或2期翻修对假体周围踝关节感染的根除率：一项系统综述。

目的：全踝关节置换术（TAR）后假体周围关节感染（PJI）的处理可能具有挑战性。我们的目的是确定一些通常用于治疗急性和慢性PJI的外科手术的根除率和局限性。方法：在这个符合prisma标准的系统评价中，检索了多个数据库，包括诊断和治疗TAR后急性或慢性PJI的临床研究。收集关于队列、研究设计、采用的诊断标准和PJI的手术治疗的数据。采用非随机研究方法学指数（minor）评价研究的方法学质量。根据研究中进行的手术程序分为三组：第一组进行清创、抗生素和种植体保留（DAIR），第二组进行1.5期翻修（1.5期），第三组进行2期翻修（2期）。结果：来自7项研究的13个队列(138例感染的TARs；40 %女性，平均年龄61.3岁)纳入2012 - 2023年间发表的研究。根除感染的定义在研究中存在差异（3项研究报告为“不再手术”，2项研究报告为临床和血清学指标正常，2项研究报告为术中培养阴性）。DAIR、1.5期和2期改良组的总根除率分别为89 %（95 %CI, 79-100）、95 %（95 %CI, 70-100）和92 %（95 %CI, 80-99）。在平均39.3个月的随访中，膝下截肢比例为7.2 %（10/138）。未成年人的得分（非比较研究和比较研究分别为7.6/16和14.6/24）表明研究质量较差。结论：在本综述中，估计DAIR、1.5和2阶段交换手术根除TAR后PJI的有效性分别为89 %、95 %和92 %。这种情况下的决策是基于低质量的小样本回顾性研究。PJI诊断后膝下截肢率为7.2% %。证据等级：四级，对四级研究的系统评价。

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来源期刊

Foot and Ankle Surgery ORTHOPEDICS-

CiteScore

4.60

自引率

16.00%

发文量

202

期刊介绍： Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.