Skip to main content

What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions.

Publication ,  Journal Article
Khan, Z; Khan, ZA; Zamora, T; Gulia, A; Lozano-Calderon, SA; Kurisunkal, VJ; Jeys, LM; BOOM Consensus Meeting participants; Laitinen, MK; Ae, K ...
Published in: Bone Jt Open
November 20, 2025

AIMS: Following resection of a primary bone tumour, reconstruction is commonly performed using either a megaprosthesis or biological reconstruction. Periprosthetic joint infection (PJI) remains one of the most frequent complications. Various treatment strategies exist for PJI, including debridement, antibiotics, and implant retention (DAIR), and single- and two-stage revision, although consensus on optimal management remains elusive. This study aimed to investigate the global practices regarding DAIR in tumour cases through an electronic survey among orthopaedic oncology surgeons. 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'.

Duke Scholars

Published In

Bone Jt Open

DOI

EISSN

2633-1462

Publication Date

November 20, 2025

Volume

6

Issue

11

Start / End Page

1495 / 1503

Location

England

Related Subject Headings

  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Khan, Z., Khan, Z. A., Zamora, T., Gulia, A., Lozano-Calderon, S. A., Kurisunkal, V. J., … Ruggieri, P. (2025). What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions. Bone Jt Open, 6(11), 1495–1503. https://doi.org/10.1302/2633-1462.611.BJO-2025-0114.R2
Khan, Zeeshan, Zainab Aqeel Khan, Tomas Zamora, Ashish Gulia, Santiago A. Lozano-Calderon, Vineet J. Kurisunkal, Lee M. Jeys, et al. “What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions.Bone Jt Open 6, no. 11 (November 20, 2025): 1495–1503. https://doi.org/10.1302/2633-1462.611.BJO-2025-0114.R2.
Khan Z, Khan ZA, Zamora T, Gulia A, Lozano-Calderon SA, Kurisunkal VJ, et al. What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions. Bone Jt Open. 2025 Nov 20;6(11):1495–503.
Khan, Zeeshan, et al. “What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions.Bone Jt Open, vol. 6, no. 11, Nov. 2025, pp. 1495–503. Pubmed, doi:10.1302/2633-1462.611.BJO-2025-0114.R2.
Khan Z, Khan ZA, Zamora T, Gulia A, Lozano-Calderon SA, Kurisunkal VJ, Jeys LM, BOOM Consensus Meeting participants, Laitinen MK, Abad Repiso S, Abdelbary H, Abiad Mejia A, Abood AA, Abou-Nouar G, Abril Martin JC, Abu Elhamd A, Abudu A, Acosta M, Ae K, Agarwal M, Ajit Singh V, Akiyama T, Albergo JI, Alexander J, Alfaro PA, Alpan B, Alshaygy I, Amaya-Valero J, Anderson M, Andreou D, Annabell L, Anthony C, Aoude A, Arteagoitia-Colino I, Asavamongkolkul A, Aston W, Asua Mentxaka L, Azzopardi C, Baad-Hansen T, Badr IT, Baixauli-Garcia F, Baker G, Balach T, Baldi GG, Barry J, Basile G, Bastoni S, Basuki MH, Bauer H, Bayliss L, Becker RG, Bedi A, Benevenia J, Bengoa F, Bergh P, Bergovec M, Bernthal N, Binitie O, Boddie D, Boffano M, Bonilla Huertas P, Borgognoni AB, Botchu R, Bramer J, Branford-White H, Brar R, Broekhuis D, Broida SE, Budny T, Burke ZD, Cabrolier J, Calvo Tapies JR, Calvo-Haro JA, Campanacci D, Cardoso R, Carey Smith R, Carvallo PI, Casales Fresenga N, Casanova JM, Ceballos O, Cebrian Parra JL, Certain LK, Chacon Cartaya S, Chan CM, Cho YJ, Choong P, Chung Y-G, Ciechanowicz D, Clara-Altamirano MA, Clever D, Colina SM, Consuegra L, Couch C, Cribb G, Cuervo C, Cusick LA, Dadia S, Dagher T, Dammerer D, Davies M, Davies N, de la Rosa Martino LP, de Santos de la Fuente FJ, de Vaal M, Deckers C, Delgado Obando J, Deo S, Deventer N, Di Bella C, Domson G, Donati DM, Dorleijn DM, Du Toit J, Dunne D, Duran Ciarrochi R, Ekman E, El Ghoneimy AM, Endo M, Eralp L, Etaiwi M, Evans S, Evrard R, Eward W, Farese A, Ferguson PC, Ferreira Cardoso PF, Fiorenza F, Flint M, Flores H, Freitas J, Fuchs B, Fujiwara T, Funovics PT, Galli Serra M, Gamie Z, Garces-Zarzalejo C, Gazendam A, Gebert C, Gerbers JG, Gerrand C, Ghert M, Ghosh KM, Gibbons M, Gomez-Mascard A, Gomez-Mier LC, Gomez-Vallejo J, Gonzalez MR, Gonzalez-Lizan F, Gosheger G, Goudie S, Goulding K, Goumenos SD, Griffin A, Gupta S, Gupta A, Guzman M, Haitham M, Hardes J, Hardoy F, Hasan Y, Hauer G, Havard H, Haydon R, Healey J, Hernandez Gonzalez N, Hernandez-Lopez A, Hesla A, Hess M, Hilton T, Hongsaprabhas C, Hornicek F, Hosking K, Houghton E, Idowu OK, Ippolito J, Isler M, Iwata S, Jagiello J, Jenkins N, Jeys T, Jeys C, Johnson L, Johnston A, Joo MW, Jutte PC, Kaldas K, Kamat A, Kannan S, Kapanci B, Kobayashi H, Kollender Y, Koob S, Kotrych D, Kyte R, Lamo de Espinosa Vazquez de Sola JM, Lazarides AL, Le Nail L-R, Legosz P, Lehner B, Leithner A, Lejoly M, Lewis VO, Lin P, Linares F, Lozano-Calderon S, Mahendra A, Mahyudin F, Mandia Mancebo FJ, Martos Torrejon S, Marx C, Mascard E, Mattei J-C, McCullough L, McMahon S, Medellin Rincon MR, Miller B, Miwa S, Molina Uribe G, Moon B, Moriel Garcesco DJ, Morris C, Morrison S, Mottard S, Moura M, Muster L, Nakayama R, Narhari P, Navas A, Nayak P, Neugebauer J, Newman ET, Nieminen J, Nyqvist E, Nystrom L, O’Reilly-Harbidge S, O’Toole G, Oliveira V, Olivier A, Omar M, Ortiz-Cruz EJ, Ozger H, Ozkan K, Pala E, Palmerini E, Pang G, Papagelopoulos P, Paraliticci G, Parry MC, Patton S, Peake D, Peiro Ibanez A, Perez Munoz I, Perianayagam GR, Petersen MM, Ploegmakers J, Pollock R, Powell G, Pretell J, Puetzler J, Qamar F, Raja A, Rajasekaran RB, Ramkumar DB, Randall RL, Rankin KS, Raskin KA, Rassppan K, Repsa L, Ropars M, Rose P, Sadek W, Salcedo G, Saleemi A, Sambri A, Sar H, Scanferla R, Schubert T, Schwarze J, Scoccianti G, Scrimshire A, Sekita T, Shehadeh A, Shoaib A, Shreemal B, Shumelinsky F, Siegel G, Silveri C, Silverwood R, Sinnaeve F, Sison J, Slade A, Smolle MA, Snyman F, Sommerville S, Sood S, Spiguel A, St-Yves H, Staals EL, Stacchiotti S, Stavropoulos N, Steadman P, Stevenson JD, Sullivan M, Sys G, Szostakowski B, Tamburini A, Taniguchi Y, Temple T, Theil C, Thorkildsen J, Tibbo M, Tillman R, Toda Y, Tootsi K, Torner Rubies F, Traub F, Trikoupis I, Tsagkozis P, Tsoi K, Tsuchiya H, Vainio V-M, Valcarcel A, Valencia J, Van Beeck A, Van de Sande M, Van Den Berghe T, Van der Geest I, Van der Heijden L, Van der Wal R, Van Langevelde K, Vaz G, Velez Villa R, Verspoor F, Verstraete K, Visgauss J, Vyrva O, Wafa H, Walter S, Wan Ismail WF, Wang E, Wang PQ, Warnock D, Werier J, Weschenfelder W, Wong K-C, Woulthuyzen-Bakker M, Wunder J, Wysinghe I, Yamamoto N, Ye Z, Yoon S-J, Zainul Abidin S, Zecchetto P, Zhang L, Zumarraga JP, Botello E, Boyle RA, Ebeid W, Houdek MT, Morris G, Puri A, Ruggieri P. What is debridement, antibiotics, and implant retention in orthopaedic oncology? : a global cross-sectional survey of surgeons' practices and opinions. Bone Jt Open. 2025 Nov 20;6(11):1495–1503.

Published In

Bone Jt Open

DOI

EISSN

2633-1462

Publication Date

November 20, 2025

Volume

6

Issue

11

Start / End Page

1495 / 1503

Location

England

Related Subject Headings

  • 3202 Clinical sciences