What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions.
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Khan Zeeshan, Khan Zainab Aqeel, Zamora Tomas, Gulia Ashish, Lozano-Calderon Santiago A, Kurisunkal Vineet J, Jeys Lee M, BOOM Consensus Meeting participants, Laitinen Minna K, Abad Repiso Santiago, Abdelbary Hesham, Abiad Mejia Alejandro, Abood Ahmed A, Abou-Nouar Ghaith, Abril Martin Juan C, Abu Elhamd Ayman, Abudu Adesegun, Acosta Marthelena, Ae Keisuke, Agarwal Manish, Ajit Singh Vivek, Akiyama Toru, Albergo Jose I, Alexander John, Alfaro Patricio A, Alpan Bugra, Alshaygy Ibrahim, Amaya-Valero Jose, Anderson Megan, Andreou Dimosthenis, Annabell Lucas, Anthony Christopher, Aoude Ahmed, Arteagoitia-Colino Iraia, Asavamongkolkul Apichat, Aston William, Asua Mentxaka Libe, Azzopardi Christine, Baad-Hansen Thomas, Badr Ismail T, Baixauli-Garcia Francisco, Baker Gavin, Balach Tessa, Baldi Giacomo G, Barry Janie, Basile Georges, Bastoni Stefano, Basuki Mohammad Hardian, Bauer Henrik, Bayliss Lee, Becker Ricardo G, Bedi Angad, Benevenia Joseph, Bengoa Francisco, Bergh Peter, Bergovec Marko, Bernthal Nicholas, Binitie Odion, Boddie David, Boffano Michele, Bonilla Huertas Patricia, Borgognoni Anna B, Botchu Rajesh, Bramer Jos, Branford-White Harriet, Brar Rahat, Broekhuis Demien, Broida Samuel E, Budny Tymoteusz, Burke Zachary Dc, Cabrolier Jorge, Calvo Tapies Jorge R, Calvo-Haro Jose A, Campanacci Dominico, Cardoso Rodrigo, Carey Smith Richard, Carvallo Pedro I, Casales Fresenga Nicolas, Casanova Jose Manuel, Ceballos Oscar, Cebrian Parra Juan Luis, Certain Laura K, Chacon Cartaya Sara, Chan Chung Ming, Cho Yoon Joo, Choong Peter, Chung Yang-Guk, Ciechanowicz Dawid, Clara-Altamirano Miguel Angel, Clever David, Colina Sebastian Matheo, Consuegra Luis, Couch Cory, Cribb Gillian, Cuervo Carlos, Cusick Laurence A, Dadia Solomon, Dagher Tanios, Dammerer Dietmar, Davies Mark, Davies Nerys, de la Rosa Martino Luis Pablo, de Santos de la Fuente Francisco Javier, de Vaal Marieke, Deckers Claudia, Delgado Obando Javier, Deo Shaneel, Deventer Niklas, Di Bella Claudia, Domson Gregory, Donati Davide Maria, Dorleijn Desiree M, Du Toit Jacques, Dunne Debra, Duran Ciarrochi Rodolfo, Ekman Elina, El Ghoneimy Ahmed M, Endo Makoto, Eralp Levent, Etaiwi Mahmoud, Evans Scott, Evrard Robin, Eward Will, Farese Alberto, Ferguson Peter C, Ferreira Cardoso Pedro Filipe, Fiorenza Fabrice, Flint Michael, Flores Hector, Freitas Joao, Fuchs Bruno, Fujiwara Tomohiro, Funovics Philipp T, Galli Serra Marcos, Gamie Zakareya, Garces-Zarzalejo Carlos, Gazendam Aaron, Gebert Carsten, Gerbers Jasper G, Gerrand Craig, Ghert Michelle, Ghosh Kanishka M, Gibbons Max, Gomez-Mascard Anne, Gomez-Mier Luis Carlos, Gomez-Vallejo Jesus, Gonzalez Marcos R, Gonzalez-Lizan Fausto, Gosheger Georg, Goudie Stuart, Goulding Krista, Goumenos Stavros D, Griffin Anthony, Gulia Ashish, Gupta Sanjay, Gupta Amit, Guzman Maurice, Haitham Mohammed, Hardes Jendrik, Hardoy Francisco, Hasan Yusuf, Hauer Georg, Havard Helard, Haydon Rex, Healey John, Hernandez Gonzalez Nerea, Hernandez-Lopez Adriana, Hesla Asle, Hess Matthew, Hilton Thomas, Hongsaprabhas Chindanai, Hornicek Francis, Hosking Keith, Houghton Eleanor, Idowu Oluwaseyi K, Ippolito Joseph, Isler Marc, Iwata Shintaro, Jagiello Jake, Jenkins Neil, Jeys Tom, Jeys Charlotte, Johnson Luke, Johnston Andy, Joo Min Wook, Jutte Paul C, Kaldas Kadri, Kamat Amar, Kannan Sudhir, Kapanci Bilal, Khan Zeeshan, Kobayashi Hiroshi, Kollender Yehuda, Koob Sebastian, Kotrych Daniel, Kyte Richard, Lamo de Espinosa Vazquez de Sola Jose Maria, Lazarides Alexander L, Le Nail Louis-Romee, Legosz Pawel, Lehner Burkhard, Leithner Andreas, Lejoly Maryse, Lewis Valerae O, Lin Peng, Linares Francisco, Lozano-Calderon Santiago, Mahendra Ashish, Mahyudin Ferdiansyah, Mandia Mancebo Fermin Julian, Martos Torrejon Sara, Marx Christian, Mascard Eric, Mattei Jean-Camille, McCullough Louise, McMahon Sam, Medellin Rincon Manuel Ricardo, Miller Benjamin, Miwa Shinji, Molina Uribe Gustavo, Moon Bryan, Moriel Garcesco Diego Jesus, Morris Carol, Morrison Stewart, Mottard Sophie, Moura Marcio, Muster Linde, Nakayama Robert, Narhari Prashant, Navas Ana, Nayak Prakash, Neugebauer Johannes, Newman Erik T, Nieminen Jyrki, Nyqvist Emmy, Nystrom Lukas, O'Reilly-Harbidge Sarah, O'Toole Gary, Oliveira Vania, Olivier André, Omar Mohamed, Ortiz-Cruz Eduardo J, Ozger Harzem, Ozkan Korhan, Pala Elisa, Palmerini Emanuela, Pang Grant, Papagelopoulos Panayiotis, Paraliticci Giovanni, Parry Michael C, Patton Sam, Peake David, Peiro Ibanez Ana, Perez Munoz Israel, Perianayagam Ganapathy Raman, Petersen Michael Mork, Ploegmakers Joris, Pollock Robin, Powell Gerard, Pretell Juan, Puetzler Jan, Qamar Faisal, Raja Anand, Rajasekaran Raja Bhaskara, Ramkumar Dipak B, Randall R Lor, Rankin Kenneth S, Raskin Kevin A, Rassppan Kumaran, Repsa Lauris, Ropars Mickael, Rose Peter, Sadek Wael, Salcedo German, Saleemi Aasim, Sambri Andrea, Sar Hartej, Scanferla Roberto, Schubert Thomas, Schwarze Jan, Scoccianti Guido, Scrimshire Ashley, Sekita Tetsuya, Shehadeh Ahmad, Shoaib Ahmed, Shreemal Bhim, Shumelinsky Felix, Siegel Geoffrey, Silveri Claudio, Silverwood Robert, Sinnaeve Friedl, Sison Jerome, Slade Andrea, Smolle Maria Anna, Snyman Franz, Sommerville Scott, Sood Sahil, Spiguel Andre, St-Yves Hugo, Staals Eric L, Stacchiotti Silvia, Stavropoulos Nikolaos, Steadman Peter, Stevenson Jonathan D, Sullivan Mikaela, Sys Gwen, Szostakowski Bartlomiej, Tamburini Angela, Taniguchi Yuta, Temple Thomas, Theil Christoph, Thorkildsen Joachim, Tibbo Meagan, Tillman Roger, Toda Yu, Tootsi Kaspar, Torner Rubies Ferran, Traub Frank, Trikoupis Ioannis, Tsagkozis Panagiotis, Tsoi Kim, Tsuchiya Hiroyuki, Vainio Veli-Matti, Valcarcel Antonio, Valencia Juan, Van Beeck Annelies, Van de Sande Michel, Van Den Berghe Thomas, Van der Geest Ingrid, Van der Heijden Lizz, Van der Wal Robert, Van Langevelde Kirsten, Vaz Gualter, Velez Villa Roberto, Verspoor Floortje, Verstraete Koenraad, Visgauss Julia, Vyrva Oleg, Wafa Hazem, Walter Sebastian, Wan Ismail Wan Faisham, Wang Edward, Wang Patrick Qi, Warnock David, Werier Joel, Weschenfelder Wolfram, Wong Kwok-Chuen, Woulthuyzen-Bakker Marjan, Wunder Jay, Wysinghe Indica, Yamamoto Norio, Ye Zhaoming, Yoon Seung-Jae, Zainul Abidin Suraya, Zamora Tomas, Zecchetto Pierluca, Zhang Liuzhe, Zumarraga Juan Pablo, Botello Eduardo, Boyle Richard A, Ebeid Walid, Houdek Matthew T, Morris Guy, Puri Ajay, Ruggieri Pietro
Аннотация
METHODS: A global cross-sectional observational survey study was distributed to 272 orthopaedic oncology surgeons who attended the BOOM Consensus Meeting in January 2024. The survey contained 19 multiple choice questions focusing on DAIR practices. Responses were collected anonymously and analyzed using descriptive statistics.
RESULTS: The survey was completed by 173/272 surgeons (64%) from 44 countries. While 62% (169/272) routinely performed radical soft-tissue debridement in DAIR, only 39% exchanged all modular components, indicating variability in surgical approaches. DAIR was more commonly performed in acute rather than chronic infections, with 55% finding it very useful in acute cases. The use of local antibiotic delivery was supported by 56%, although only 49% found antibiotic cement coatings beneficial. Systemic antibiotic duration post-DAIR varied, with 39% favouring six weeks and 35% preferring three months.
CONCLUSION: The study highlights global inconsistencies in DAIR practices for PJI in orthopaedic oncology, with financial disparities impacting modular component exchange. Standardized definitions are lacking, and we propose that if only polyethylene is changed, then the procedure is referred to as 'poly exchange'; we recommend defining the procedure as DAIR when extensive debridement, lavage, and removal, wash, and reimplanting of all modular components is done while retaining stable stems, followed by suppressive antibiotic therapy; and finally, we recommend that if all the modular components are changed for new ones, the procedure is referred to as 'DAIR plus'.