Mini Review on the Impact of Mobile Parts' Exchange During the DAIR Procedure (Debridement, Antibiotics, Irrigation, Retention) for Infected Total Joint Arthroplasties

Abstract

A prosthetic joint infection (PJI) requires a combined approach (infectiology and surgery). The therapeutic DAIR approach (debridement, antibiotics, irrigation, and retention) is an option for acute and stable PJI yielding remission incidences that oscillate between 70% and 90%; in a literature mostly composed of retrospective single-center trials. DAIR can be performed with or without mobile part's exchange during debridement. Scientific data proving the necessity of mobile part exchanges (by leaving other infected components in situ) remain scarce. In this narrative mini review, we evaluate the existing literature that analyses the benefit of exchanging mobile parts with at least ten own cases. We moreover discuss the optimal duration of concomitant targeted systemic antibiotic therapy and reveal some insights in the surgical difficulties in performing DAIR. Our conclusion tends to favor of the mobile part's exchange whenever feasible.

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

“…Chronic suppressive antibiotic therapy is a conservative approach to PJI, usually reserved for patients who are unfit for or refuse further surgical management, and has poor success rates. 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.…”

“…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.…”