ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020
Salvage procedure for chronic periprosthetic knee infection: the application of DAIR results in better remission rates and infection-free survivorship when used with topical degradable calcium-based antibiotics.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 28 citations in OpenAlex.
- Antibiotic-loaded calcium sulphate beads in in debridement, antibiotics, and implant retention (DAIR) for acute hip and knee periprosthetic joint infection: a retrospective comparative cohort study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Diagnostic yield and number needed to screen for cervical and concomitant spinal injuries in geriatric head trauma.Brain & spine · 2026Article
- Gentamicin fails to eradicateJournal of bone and joint infection · 2026Article
- Integrating Super-Oxidised Solutions into Multimodal Strategies for Orthopaedic Infection Prevention and Management.Cureus · 2025Review
- Managing Nonunions and Fracture-Related Infections-A Quarter Century of Knowledge, and Still Curious: A Narrative Review.Journal of clinical medicine · 2025Review
- Simultaneous Bilateral Methicillin-Resistant Staphylococcus aureus Infection After Total Knee Arthroplasty Successfully Treated with Continuous Local Antibiotic Perfusion: A Case Report.The American journal of case reports · 2025Article
- Current Concepts of Local Antibiotic Delivery in Bone and Joint Infections-A Narrative Review of Techniques and Clinical Experiences.Microorganisms · 2025Review
- 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 · 2024Article
- Article
- Successful Implant Retention in a Chronified Hematogenous Bilateral Periprosthetic Hip Joint Infection WithArthroplasty today · 2024Article
- The optimal diagnostic cut-off of WBC and PMN counts for joint aspiration in periprosthetic joint infection is 2479/µL and 67%, respectively: ICM criteria thresholds are too high.Archives of orthopaedic and trauma surgery · 2023Article
- Enough is enough: salvage procedures in severe periprosthetic joint infection.Arthroplasty (London, England) · 2023Review
- Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study.BMC musculoskeletal disorders · 2023Article
- Periprosthetic Joint Infection WithArthroplasty today · 2022Article
- Wound fluid ceftriaxone concentrations after local application with calcium sulphate as carrier material in the treatment of orthopaedic device-associated hip infections.Bone & joint research · 2022Article
- [Implementation of a standardized clinical test kit for diagnostics of periprosthetic infections in the clinical routine. German version].Der Unfallchirurg · 2022Article
- Do Antibiotic-Loaded Calcium Sulfate Beads Improve Outcomes After Debridement, Antibiotics, and Implant Retention? A Matched Cohort Study.Arthroplasty today · 2022Article
- Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty - a retrospective study.Journal of bone and joint infection · 2022Article
- Implementation of a standardized clinical test kit for diagnostics of periprosthetic infections in the clinical routine.Der Unfallchirurg · 2021Article
- Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study.Antibiotics (Basel, Switzerland) · 2021Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDebridement, systemic antibiotics and implant retention (DAIR) is very successful for early periprosthetic joint infection (PJI), but can fail in late-onset cases. We selected patients with PJI who were unsuitable for two-stage exchange total knee arthroplasty (TKA) and compared the outcomes of DAIR with or without degradable calcium-based antibiotics.
methodsAll patients fulfilled the criteria for late-onset PJI of TKA, as defined by an International Consensus Meeting in 2013, but were unsuitable for multistage procedures and TKA exchange due to operative risk. Fifty-six patients (mean age: 70.6 years, SD ± 10.8), in two historical collectives, were treated using a single-stage algorithm consisting of DAIR without antibiotics (control group, n = 33, 2012-2014), or by DAIR following the implantation of degradable antibiotics as indicated by an antibiogram (intervention group, n = 23, 2014-2017). OSTEOSET
resultsThere were no significant differences between the two groups in terms of mean age, Charlson comorbidity index or the rate of mixed infections. Overall, 65.2% of patients achieved remission in the intervention group compared with only 18.2% in the control group (p < 0.001); 50% of re-infections in the intervention group even occurred after 36 months. Kaplan-Meier analysis showed that, compared with controls, the intervention group experienced significantly longer 3-year infection-free survival.
conclusionDAIR shows poor efficacy in difficult-to-treat cases, as demonstrated in our control group, which had a re-infection rate of 81.8%. In contrast, a DAIR group receiving topical calcium-based antibiotics showed significantly higher 3-year infection-free survival. Therefore, the combination of DAIR and degradable antibiogram-based local antibiotics is a reasonable salvage procedure for this body of patients. This is important as the number of severely sick patients who are too old for appropriate PJI treatment is estimated to increase significantly due to demographic change.
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