JOA - 2026-05-20 - Journal Article
Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection after Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Bałoniak A, Jancevski T, Martins EC
Topics
Key Takeaway
DAIR for PJI after UKA yields 72% infection-free survival and 67% all-cause implant survival, with a 34% conversion-to-TKA rate across 165 patients.
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Summary
This systematic review and meta-analysis evaluated DAIR outcomes for PJI following UKA using a random-effects single-arm model across 9 studies. Pooled infection-free survival was 72% (95% CI 60–82%) by proportion analysis and 62% (95% CI 38–82%) by Kaplan-Meier pooling, with all-cause implant survival of 67% (95% CI 34–89%). S. aureus accounted for 39% of organisms, repeat DAIR was required in 17%, and 34% ultimately required conversion to TKA.
Key Limitation
The total cohort of 165 patients across 9 studies is underpowered and methodologically heterogeneous, precluding any subgroup analysis by infection timing (acute postoperative vs. hematogenous vs. chronic), which is the primary determinant of DAIR success in established PJI guidelines.
Original Abstract
BACKGROUND
This study aimed to evaluate the effectiveness of debridement, antibiotics, and implant retention (DAIR) in treating periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA).
METHODS
A systematic search of PubMed, Embase, and Cochrane Library was performed to identify studies reporting outcomes of DAIR for PJI after UKA. A single-arm meta-analysis using a random-effects model was conducted to estimate the pooled infection-free survival and all-cause implant survival. Additionally, pooled Kaplan-Meier survival estimates were calculated when time-to-event data were available. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Subgroup analyses based on the duration of follow-up were performed, and publication bias was evaluated using funnel plots. Outlier studies were identified using sensitivity analysis.
RESULTS
Overall, nine studies including 165 patients who had medial and lateral UKA were included in the analysis. Across studies with follow-up ranging from one year to more than 10 years, infection-free survival following DAIR was 72% (95% confidence interval [CI], 60 to 82), and all-cause implant survival was 67% (95% CI, 34 to 89) in the pooled proportion analysis. In the pooled Kaplan-Meier survival analysis, the infection-free survival rate was 62% (95% CI, 38 to 82). The incidence of conversion to TKA was 34% (95% CI, 17 to 57), and repeat DAIR was 17% (95% CI, 11 to 25). The pooled incidence of S. aureus was 39% among cases treated with DAIR (95% CI, 30 to 49).
CONCLUSION
A DAIR for treating PJI following UKA demonstrated moderate infection control rates. Given the limited availability of comparative UKA-specific data, further studies directly comparing DAIR with one- and two-stage revision strategies are needed to better define the optimal treatment pathways for this patient population.