Abstract
Background
Periprosthetic joint infection (PJI) is a devastating complication of total joint
arthroplasty (TJA). Rifampin is an antibiotic with the ability to penetrate bacterial
biofilms, and thus has been considered as a potentially important adjunct in the prevention
and treatment of PJI. The aim of this systematic review is to evaluate and summarize
the use of rifampin in TJA, particularly in the context of PJI.
Methods
A literature search of all relevant electronic databases was performed. All comparative
studies assessing the use of rifampin in the context of TJA were included. Descriptive
data are reported, and a meta-analysis was performed using all studies which compared
the addition of rifampin to standard care in treating PJI.
Results
A total of 33 studies met inclusion criteria. A meta-analysis of 22 studies comparing
the addition of rifampin to standard care for treating PJI found a significant reduction
in failure rates (26.0% vs 35.9%; odds ratio 0.61, 95% confidence interval 0.43-0.86).
The protective effect of rifampin was maintained in studies which included exchange
arthroplasty as a treatment strategy, but not in studies only using an implant retention
strategy. Among studies reporting adverse events of rifampin, there was a 20.5% adverse
event rate.
Conclusion
Overall, rifampin appears to confer a protective effect against treatment failure
following PJI. This treatment effect is particularly pronounced in the context of
exchange arthroplasty. Further high-level evidence is needed to clarify the exact
indications and doses of rifampin which can most effectively act as an adjunct in
the treatment of PJI.
Level of evidence
Level III, Systematic Review and Meta-Analysis of Level I-III Studies.
Keywords
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Article info
Publication history
Published online: March 25, 2022
Accepted:
March 22,
2022
Received in revised form:
March 10,
2022
Received:
January 31,
2022
Footnotes
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.03.072.
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