Treatment Success of Periprosthetic Joint Infections in Oncologic Endoprostheses After Standardization of Surgical Strategies-A Systematic Review of the Literature.

Abstract

Periprosthetic joint infection (PJI) is a frequent complication after oncologic endoprosthetic reconstruction and is associated with high complication and amputation rates. Current challenges for adequate treatment of endoprosthetic PJIs include insufficient data on infection microbiology and inconsistencies in classification of surgical strategies. Our study sought to examine the microbiology and treatment success of PJIs in this population before and after standardization. A systematic review following the PRISMA guidelines was done. The PubMed and Embase databases were queried, and studies were screened for inclusion and exclusion criteria. Five major treatment strategies were established: débridement, antibiotics, and implant retention (DAIR), DAIR plus, one-stage revision, two-stage revision, and amputation. DAIR entailed irrigation and débridement without component exchange, whereas DAIR plus comprised modular component exchange and implant retention. One-stage revision required the exchange of all implants in a single surgery, whereas two-stage revision involved this process over two surgeries with temporary spacer insertion. PJI treatment success was evaluated for each surgical strategy, comparing outcomes based on the original nomenclature used by study authors to those after reclassification. A total of 22 studies comprising 975 patients with endoprosthetic PJIs were included. The most commonly isolated microorganisms were coagulase-negative Staphylococcus (36.4%) and Staphylococcus aureus (27.5%). Culture-negative PJIs occurred in 10.3% of cases. After reclassification, the treatment success rates of DAIR plus increased from 45.8% to 63.1% ( P < 0.001), whereas that of DAIR diminished from 51.8% to 39.7% ( P = 0.01). The treatment of one-stage revision improved from 60.2% to 75% ( P = 0.01), whereas that of two-stage revision (71.8% versus 73.5%, P = 0.2) and amputation (100% in both) remained unchanged after reclassification. Reclassification using standardized definitions demonstrated changes in reported treatment efficacy. Our study underscored the influence of stem removal on the efficacy of surgical treatment. III.