Antonio Izzo, Claudia Carbone, Vincenzo De Matteo, François Lintz, Enrico Festa, Giovanni Balato, Alessio Bernasconi
{"title":"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。","authors":"Antonio Izzo, Claudia Carbone, Vincenzo De Matteo, François Lintz, Enrico Festa, Giovanni Balato, Alessio Bernasconi","doi":"10.1016/j.fas.2025.05.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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 %.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level IV studies.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Antonio Izzo, Claudia Carbone, Vincenzo De Matteo, François Lintz, Enrico Festa, Giovanni Balato, Alessio Bernasconi\",\"doi\":\"10.1016/j.fas.2025.05.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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 %.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level IV studies.</p>\",\"PeriodicalId\":48743,\"journal\":{\"name\":\"Foot and Ankle Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-05-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Foot and Ankle Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.fas.2025.05.006\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot and Ankle Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.fas.2025.05.006","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
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.
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.
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.
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