Evidence map›Paper›PMID 38183061›Full record

ArticleBMC musculoskeletal disorders2024

DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study.

Yukichi Zenke, Yasuhito Motojima, Kohei Ando, Kenji Kosugi, Daishi Hamada, Yasuaki Okada, Naohito Sato, Daichi Shinohara, Hitoshi Suzuki, Makoto Kawasaki and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC musculoskeletal disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
4.6field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 8 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Yukichi ZenkeDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan. ukichi.drz@gmail.com.
Yasuhito MotojimaDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Kohei AndoDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Kenji KosugiDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Daishi HamadaDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Yasuaki OkadaDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Naohito SatoDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Daichi ShinoharaDepartment of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
Hitoshi SuzukiDepartment of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan.
Makoto KawasakiDepartment of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan.
Akinori SakaiDepartment of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan.
University of Occupational and Environmental Health Japan · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntimicrobial agents are administered via intramedullary antibiotic perfusion (iMAP)/intrasoft tissue antibiotic perfusion (iSAP) to infected lesions to control osteoarticular and soft tissue infections. Continuous local antibiotic perfusion (CLAP) has been reported to be useful. This study aimed to investigate the outcomes of DAIR combined with CLAP for chronic PJI after total knee arthroplasty performed at our hospital. SUBJECTS AND

methodsSix patients (male; one case, female; five cases, mean age 79.5 years (70-94)) underwent CLAP for chronic PJI after TKA at our hospital between July 2020 and June 2022. They were followable for at least one year after surgery. Seven months (17-219), with a mean follow-up of 24.3 months (12-36). In addition to direct debridement and insert exchange, systemic antimicrobial treatment, and CLAP with gentamicin were performed using NPWT. We investigated the organisms causing the inflammation, the duration of iMAP/iSAP implantation, the maximum daily dose of GM, the maximum GM blood concentration, and the presence or absence of GM-induced adverse events.

resultTwo of six patients had a recurrence of infection at five weeks and five months after initial CLAP and required repeat CLAP treatment, but all patients could preserve their components. The organisms responsible for the flare-ups were MSSA in three cases: ESBL-producing E. coli, mixed MSSA and streptococcal infection, Klebsiella pneumonia in one case each, and unknown pathogens in one case. CLAP therapy for all patients was administered eight times in 6 cases: iMAP, mean: 10.0 days (5-16); iSAP, mean: 19.3 days (15-28); GM dose, mean: 162.5 mg/day (80-240); and GM blood concentration, mean: 1.4 µg/mL (0.2-5.0). Adverse events included one case of reversible acute kidney injury during CLAP in a patient with recurrent infection. DAIR with CLAP for chronic post-TKA infection can be a useful treatment option to preserve components and allow the infection to subside, provided the implant is not markedly loosened.

Indexed as

Arthroplasty, Replacement, KneeAgedAnti-Bacterial AgentsEscherichia coliFemaleGentamicinsHumansMalePerfusionPersistent InfectionAnti-Bacterial AgentsGentamicinsAntibioticsChronic InfectionContinuous local antibiotic perfusion therapy (CLAP)DebridementImplant retention (DAIR)Postoperative total knee arthroplasty

Identifiers

PMID38183061
PMCPMC10768161
OpenAlexW4390607410

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.