The use of debridement, antibiotic pearls, and implant retention (DAPRI) in the management of acute periprosthetic joint infections: a systematic review

Abstract. Background: Periprosthetic joint infection (PJI) represents one of the most severe complications following joint arthroplasty, largely due to bacterial biofilm formation on implant surfaces. While debridement, antibiotics and implant retention (DAIR) is commonly used for acute infections, its effectiveness remains variable. Debridement, antibiotic pearls and implant retention (DAPRI) has been proposed as a modified technique aimed at improving local antibiotic delivery and biofilm eradication. This systematic review evaluates the current evidence on the effectiveness and safety of DAPRI in PJI management. Materials and methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus and Web of Science databases were searched for studies reporting the use of DAPRI in adult patients with PJI. Eligible studies included retrospective studies and case series reporting surgical details and postoperative outcomes. Methodological quality was assessed using the MINORS score. Demographic data, microbiology, antibiotic regimens and clinical outcomes were analysed. Results: Five studies involving 128 patients met the inclusion criteria. The mean patient age was 69.4 years, with a mean follow-up of 22.4 months. PJIs involved the knee (n=78), hip (n=44) and shoulder (n=6). Gram-positive organisms predominated, with Staphylococcus aureus (32 %) and S. epidermidis (28.9 %) being the most frequently isolated pathogens. Infection eradication was achieved in 105 cases, corresponding to an overall success rate of 82 %. Twenty-three patients (18 %) required further surgical intervention. Reported complications were limited and included wound dehiscence, renal dysfunction and heterotopic ossification. Conclusions: DAPRI appears to be a promising implant-retention strategy for the treatment of PJI, showing encouraging infection eradication rates with a low incidence of complications. However, the current evidence is limited by small sample sizes, heterogeneity in patient selection, surgical technique and antibiotic protocols, as well as the lack of comparative studies. High-quality prospective trials are needed to better define the role of DAPRI relative to established surgical approaches.