Evaluation One Year after DAIR Treatment in 91 Suspected Early Prosthetic Joint Infections in Primary Knee and Hip Arthroplasty

Abstract

Introduction: Early recognition and appropriate initial treatment with debridement, antibiotics and implant retention (DAIR) if a suspicion of an early prosthetic joint infection (PJI) is present can eradicate infection on first attempt and prevent implant failure. We evaluated the outcome after 1 year of patients treated with DAIR after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Furthermore, we determined preoperative, microbiology, and treatment factors related to failure after DAIR.Methods: A retrospective cohort study was assembled with 91 patients undergoing DAIR with a high suspicion of an early PJI. Records were reviewed for demographics, preoperative laboratory results, microbiological data, given treatment and postoperative follow-up. The primary outcome was infection-free implant survival at 1 year. Repeated DAIR was not considered as treatment failure.Results: The rate of infection-free implant survival following DAIR in a suspected early PJI was 85% (95% confidence intervals (CI) 78-91). Cultures remained negative in 20 patients, with no occurrence of infection during follow-up. A higher failure rate was seen in early PJI caused by Enterococcus faecalis (p=0.04). Multivariate analysis showed a statistically significant association between treatment failure and high C-reactive protein level (CRP >100) (odds ratio 10.0, 95% CI [1.5-70]) and multiple DAIR procedures (≥2) (odds ratio 5.0, 95%CI [1.1-23]).Conclusion: If an early PJI is suspected DAIR is the appointed treatment with up to 2 debridement procedures. Since culture-negative DAIRs were not related to any complications during follow-up, overtreatment of suspected PJI seems to do no significant harm with respect to implant failure.

Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention

“…In this study of patients with PJI after primary THA, DAIR with exchange of components was more successful than non-exchange DAIR. The success rates, although evaluated using a reoperation as the end point, lie within the range of previously reported rates 3 - 8 . There is existing evidence that an exchange improves success rates 4 , 8 , 11 , 13 , but it should be noted that the results were based mainly on smaller study samples.…”

“…Patients infected with S. aureus or S. lugdunensis had a higher risk of having a reoperation than those with a CoNS infection. CoNS infections were associated with treatment failure in a previous study 10 , but they have also been reported be associated with outcomes equal to those of S. aureus PJI 3 . We did not have access to resistance profiles of causative microbes, and our finding is difficult to explain.…”

“…To our knowledge, the current study is the largest on DAIR after primary THA. As DAIR fails in 13% to 63% of patients 3 - 10 , additional efforts, such as evaluating the procedure in randomized trials, should be made to identify how DAIR should best be conducted and who benefits from it 3 - 7 .…”

“…Treatment of these PJIs requires multiple considerations such as the type of infection and the patient’s status and preferences 2 . The definitions of successful debridement, antibiotics, and implant retention (DAIR) vary, and reported success rates have ranged from 37% to 87% 3 - 10 . Numerous factors influence the success, such as timing of surgery, type of bacterial growth, choice of antimicrobial therapy, and individual patient and surgical factors 4 , 5 , 10 - 12 .…”

Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip

“…В нашей когорте из 26 пациентов с ранней послеоперационной и острой гематогенной ППИ, пролеченных по протоколу хирургической обработки с сохранением имплантата, частота контроля над инфекцией за период наблюдения 5,5 лет составила 80,8%. Полученные нами результаты успешного лечения ранней ППИ сопоставимы с результатами современных исследований, в которых авторы применяли указанный метод лечения [1, 5, 12, 13, 14, 15,16].…”