Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection—An 18-Year Experience

Grammatopoulos, George; Kendrick, Benjamin; McNally, Martin; Athanasou, Nicholas A.; Atkins, Bridget L.; McLardy-Smith, P.; Taylor, Adrian; Gundle, R

doi:10.1016/j.arth.2017.02.066

Cited by 99 publications

(88 citation statements)

References 42 publications

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“…periprosthetic fracture) we found that infected patients had self-reported equivalent functional outcomes to uninfected controls. This finding that is also corroborated by other studies (13,14), suggests that an early DAIR procedure is a "benign" procedure with no significant impact on joint function.…”

Section: Discussionsupporting

confidence: 86%

Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact

Barros

Amorim-Barbosa

Esteves

et al. 2019

J. Bone Joint Infect.

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Introduction: Debridement, antibiotics and implant retention (DAIR) is known to be effective in treating acute periprosthetic joint infection (PJI). However, deciding to perform additional surgery in the early postoperative period may be challenging as there is the concern of adding morbidity and clinical presentation is often subtle. We mean to assess the impact of early DAIR on final functional outcome. Methods: A case-control comparison was performed between patients that underwent DAIR for suspected PJI between 2010-2016 and controls randomly selected (1:2 ratio) from a list of primary joint replacements. Patients were matched for anatomic site, age, gender, American Society of Anesthesiologists (ASA) classification, body mass index and follow-up time. The outcome of surgical treatment and complications were assessed and Hip disability and Osteoarthritis Outcome Score (HOOS) or Knee injury and Osteoarthritis Outcome Score (KOOS) were performed. Results: Thirty-eight cases were included at a mean follow-up of 42 months. Infection was not confirmed in one patient. There was one infection related-death and three other cases of treatment failure that required a two-stage revision. Overall success rate was 89.2%. There were no significant patient reported differences regarding final functional outcome between both groups: pain 91±6 vs. 87±13; other symptoms 90±8 vs. 90±9; activities of day living 86±8 vs. 85±14; sport 63±13 vs. 57±16; quality of life 78±17 vs. 76±16. Discussion: These findings support that DAIR for suspected acute PJI is safe, effective and causes no impact on final functional results. Thus, a low threshold for assuming infection and subsequent DAIR may safely be adopted in the early postoperative period.

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Section: Discussionsupporting

confidence: 86%

Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact

Barros

Amorim-Barbosa

Esteves

et al. 2019

J. Bone Joint Infect.

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“…In one of the largest studies reporting treatment outcomes following the DAIR procedure in hip PJI, exchanging the modular components was reported to be associated with about a 4-fold chance of infection eradication. (65) We were also unable to assess infection control rates across other relevant clinical characteristics such as sex, comorbidities, and whether single or repeat DAIR procedures were performed in patients, because of the lack of appropriate data in contributing studies. Given the substantial heterogeneity among the contributing studies, it was arguable whether a summary estimate should be presented.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes

Kunutsor

Beswick

Whitehouse

et al. 2018

Journal of Infection

115

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“…9 The prosthesis at this stage is usually sound (not loose) and the most appropriate management is a DAIR procedure (a radical open Debridement with exchange of modular components but Retention of the Implant followed by Antibiotics). 10 This needs to be done by an orthopaedic surgeon experienced in managing PJIs. Joint aspiration / arthroscopic washout may be required as an interim measure to drain pus if the relevant expertise is not immediately available.…”

Section: Acute Septic Arthritismentioning

confidence: 99%

Bone and joint infection

Colston

Atkins

2018

Clinical Medicine

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Bone and joint infections include septic arthritis, prosthetic joint infections, osteomyelitis, spinal infections (discitis, vertebral osteomyelitis and epidural abscess) and diabetic foot osteomyelitis. All of these may present through the acute medical take. This article discusses the pathogenesis of infection and highlights the importance of taking a careful history and fully examining the patient. It also emphasises the importance of early surgical intervention in many cases. Consideration of alternative diagnoses, appropriate imaging and high-quality microbiological sampling is important to allow appropriate and targeted antimicrobial therapy. This article makes some suggestions as to empiric antibiotic choice; however, therapy should be guided by local antimicrobial policies and infection specialists. Involvement of a multidisciplinary team is essential for optimal outcomes.

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Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection—An 18-Year Experience

Cited by 99 publications

References 42 publications

Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact

Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact

Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes

Bone and joint infection

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