Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention)

Kuiper, Jesse W P; Vos, Stan J.; Saouti, Rachid; Vergroesen, Diederik A.; Graat, Harm C.A.; Debets-Ossenkopp, Yvette J.; Peters, Edgar J.G.; Nolte, Peter A.

doi:10.3109/17453674.2013.823589

Cited by 154 publications

(174 citation statements)

References 33 publications

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“…Unfortunately, to date, no comparative studies between different strategies are available and therefore no hard recommendations regarding which one to use can be made. For every strategy different studies are published with results ranging from poor to excellent (21% to 90% success rate) [49,[52][53][54] . All of them are retrospective case-series, which are often quite heterogeneous regarding inclusion, exact treatment and outcomes.…”

Section: Risk Factors For (Acute) Pjimentioning

confidence: 99%

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Kuiper

Willink

Moojen

et al. 2014

WJO

109

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Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one-or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients. Key words: Arthroplasty; Prosthesis; Infection; Periprosthetic joint infection; Retention; Debridement antibiotics and implant retention; Debridement; Acute Core tip: Acute periprosthetic joint infection (PJI) is a major complication after total joint arthroplasty, and occurs either postoperatively or via hematogenous spreading. Debridement, antibiotics and implant retention (DAIR), the primary treatment for acute PJI, should be performed as soon as possible after the development of symptoms, and has success rates around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. Sys- REVIEW

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Section: Risk Factors For (Acute) Pjimentioning

confidence: 99%

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Kuiper

Willink

Moojen

et al. 2014

WJO

109

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“…However, the purpose of the present study was to evaluate only studies reporting on hip joint infections. Several well-designed studies with a higher level of evidence report about DAIR including both THA and total knee arthroplasty (TKA) cases, whereas a differentiation of the results between both primary surgeries is not possible [15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Similar to that, other studies present data only about small case series [29][30][31] .…”

mentioning

confidence: 99%

“…Various risk factors have been described that are associated with occurrence of PJI, such as rheumatoid arthritis, diabetes mellitus, malignancy, obesity, and use of immunosuppressive drugs [15,20,[32][33][34] . Revision surgery also increases the conclusions.…”

mentioning

confidence: 99%

“…Periprosthetic joint infections (PJI) still remain a hazardous complication after primary and revision THA. A regimen of debridement, irrigation, prosthesis retention, and antibiotic therapy is generally accepted for acute infections without complicating factors such as significant comorbidity, not intact soft tissues surrounding the prosthesis or loosening of the prosthesis [15] . The aim of the present review was to investigate whether it is possible to treat these infections by prosthesis retention.…”

mentioning

confidence: 99%

“…67.50% Westberg et al [14] Debridement, pulsatile lavage, risk of PJI [17,33,34] . Factors that have been associated with a worse outcome of PJI treatment including both THA and TKA involve infections caused by Staphylococcus species [15] , and more specifically by Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) [17,[35][36][37] , polymicrobial PJI [20] , intra-articular purulence [15] , retention of exchangeable components [20] , and longer time between initial arthroplasty and PJI diagnosis [16,20,36,38] . Despite the aforementioned known risk factors the ideal treatment procedure is difficult to choose due to the definition of the infection itself.…”

mentioning

confidence: 99%

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Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

Anagnostakos

Schmitt

2014

WJO

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To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention. A literature search was performed through PubMed until September 2013. Search terms were "DAIR (debridement, antibiotics, irrigation, and retention)" alone and in combination with "hip" as well as "hip infection + prosthesis retention". A total of 11 studies reporting on 292 cases could be identified. Five different treatment modalities have been described with varying success rates (debridement-21% infection eradication rate; debridement + lavage-75% infection eradication rate; debridement, lavage, with change of modular prosthesis components-70.4% infection eradication rate; debridement, lavage, change of modular prosthesis components + vacuum-assisted closure-92.8% infection eradication rate; acetabular cup removal + spacer head onto retained stem-89.6% infection eradication rate). With regard to the postoperative antibiotic therapy, no general consensus could be drawn from the available data. Debridement, antibiotic therapy, irrigation, and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections. The current literature does not allow for generalization of conclusions with regard to the best treatment modality. A large, multi-center study is required for identification of the optimal treatment of these infections.

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Longitudinal Model of Periprosthetic Joint Infection in the Rat

Fan

Xiao

Sabuhi

et al. 2019

Journal Orthopaedic Research

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The majority of periprosthetic joint infections occur shortly after primary joint replacement (<3 months) and require the removal of all implant components for the treatment period (~4 months). A clinically relevant animal model of periprosthetic infection should, therefore, establish an infection with implant components in place. Here, we describe a joint replacement model in the rat with ultrahigh molecular weight polyethylene (UHMWPE) and titanium components inoculated at the time of surgery by methicillin-sensitive Staphylococcus aureus (S. aureus), which is one of the main causative microorganisms of periprosthetic joint infections. We monitored the animals for 4 weeks by measuring gait, weight-bearing symmetry, von Frey testing, and micro-CT as our primary endpoint analyses. We also assessed the infection ex vivo using colony counts on the implant surfaces and histology of the surrounding tissues. The results confirmed the presence of a local infection for 4 weeks with osteolysis, loosening of the implants, and clinical infection indicators such as redness, swelling, and increased temperature. The utility of specific gait analysis parameters, especially temporal symmetry, hindlimb duty factor imbalance, and phase dispersion was identified in this model for assessing the longitudinal progression of the infection, and these metrics correlated with weight-bearing asymmetry. We propose to use this model to study the efficacy of using different local delivery regimens of antimicrobials on addressing periprosthetic joint infections. Statement of clinical significance: We have established a preclinical joint surgery model, in which postoperative recovery can be monitored over a multi-week course by assessing gait, weight-bearing, and allodynia. This model can be used to study the efficacy of different combinations of implant materials and medication regimens.

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Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention)

Cited by 154 publications

References 33 publications

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

Longitudinal Model of Periprosthetic Joint Infection in the Rat

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