Contemporary outcomes of debridement, antibiotics and implant retention (DAIR) in hip arthroplasty

Bolduc, Marie-Ève; Fischman, Daniel; Kendrick, Ben; Taylor, Adrian; Grammatopoulos, George

doi:10.21037/aoj-20-87

Cited by 1 publication

(23 citation statements)

References 42 publications

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“…5,15,16 One-and twostage revision arthroplasties show the highest success rates for PJI eradication but are paired with more significant patient burden, prolonged hospitalisation, soft tissue and bony defects, and higher costs. 4,8,14,15,17 Resection arthroplasty can be considered in low-functioning, non-ambulatory patients with bony or soft tissue defects, those with resistant organism infections, and patients with failed two-stage revisions where antibiotic suppression and further implant intervention are unlikely to be successful. 7 Arthrodesis and amputation may be considered as last resort options for patients due to the severe impairment of functionality and quality of life, and are reserved for patients where other surgical options have failed.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Although DAIR is considered less invasive than two-stage revision procedures, it is not to be thought of as a simple washout, and it is suggested that a senior surgeon perform the surgery. 4 Pre-and postoperative optimisation of the patient is required to minimise operative risks. DAIR is performed via the index surgery's approach in open procedures.…”

Section: Dair Approachmentioning

confidence: 99%

“…Heterogeneity of cohorts, length of follow-up, inclusion and exclusion criteria, and definitions of success and failure are all factors adding to the overall rates of success reported. 4 Table I summarises the success rates for DAIR reported in the literature, but whether a success rate of 50% should discourage DAIR is debatable, as it should be decided on a caseby-case basis whether the potential benefits for a successful DAIR outweigh the consequences of failure. 19…”

Section: Success Ratesmentioning

confidence: 99%

“…3 The incidence of PJI is estimated at 0.5-2%, with knee arthroplasty at 0.8-1.9% and hip arthroplasty at 0.3-1.7%. 4,5 PJI is a devastating complication of total joint arthroplasty and significantly increases the burden on the patient, the surgeon and the healthcare system. Prolonged hospitalisation, multiple surgical procedures, psychological stressors of progressive disease, increased healthcare costs, loss of income and physical disability all add to the burden of PJI and reflect as diminished patient outcomes concerning morbidity, quality of life and mortality rates.…”

Section: Introductionmentioning

confidence: 99%

“…Prolonged hospitalisation, multiple surgical procedures, psychological stressors of progressive disease, increased healthcare costs, loss of income and physical disability all add to the burden of PJI and reflect as diminished patient outcomes concerning morbidity, quality of life and mortality rates. 2,4,6 PJI is a leading cause of revision arthroplasty, as the management of the condition frequently requires a combination of surgical and medical intervention. 7 Eradicating a PJI while retaining a viable and functional prosthesis remains a challenge due to multiple variables, including patient condition, the infective organism, surgical approach and antimicrobial use.…”

Section: Introductionmentioning

confidence: 99%

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Truth or DAIR? A review of debridement, antibiotics and implant retention

2022

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Debridement, antibiotics and implant retention (DAIR) is a viable treatment option in early postoperative and acute haematogenous periprosthetic joint infections (PJIs) with a stable implant. Despite lower success rates compared to one- and two-stage revisions, DAIR maintains satisfactory outcomes in selected patient groups and, if successful, has similar functional outcomes to primary arthroplasty. DAIR remains an attractive treatment option, providing satisfactory outcomes with decreased healthcare costs, reduced surgical burden on the patient and shorter hospital stays. With success rates of 37-90%, various factors need to be considered when deciding on DAIR as the appropriate treatment option for PJI. The risk of DAIR failure needs to be weighed against the potential benefits of DAIR success. Factors that increase success rates include an open DAIR procedure performed for a low-virulence, antibiotic-sensitive organism, within a short duration between symptom onset and/or index surgery and DAIR. The procedure involves intraoperative exchange of mobile components and copious wound irrigation, followed by an appropriate antibiotic regimen for a minimum of six weeks that can be administered either intravenously or orally in a well-optimised host, without significant soft tissue defects or contraindications to surgery. Factors increasing the risk for DAIR failure include chronic/late PJIs with resistant organisms, especially methicillin-resistant Staphylococcus aureus (MRSA) in poor hosts with significant comorbidities, such as chronic obstructive pulmonary disease (COPD), liver cirrhosis, rheumatoid arthritis, advanced age > 80 years, patients with fracture indications for arthroplasty and those who cannot tolerate rifampicin- and fluoroquinolone-based antibiotic regimens. Unfortunately, there is no definitive factor to serve as an indication of whether DAIR will be successful, but with recent data showing that a failed DAIR procedure does not lower success in future staged revisions, then even in the face of a 50% success rate, DAIR can maintain its role as an initial treatment option in the management of PJIs

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