The Benefice of Mobile Parts’ Exchange in the Management of Infected Total Joint Arthroplasties with Prosthesis Retention (DAIR Procedure)

Abstract

Background: The management of prosthetic joint infections (PJI) with debridement and retention of the implant (DAIR) has its rules. Some authors claim that lacking the exchange of mobile prosthetic parts is doomed to failure, while others regard it as optional. Methods: Single-center retrospective cohort in PJIs treated with DAIR. Results: We included 112 PJIs (69 total hip arthroplasties, 9 medullary hip prostheses, 41 total knee arthroplasties, and 1 total shoulder arthroplasty) in 112 patients (median age 75 years, 52 females (46%), 31 (28%) immune-suppressed) and performed a DAIR procedure in all cases—48 (43%) with exchange of mobile parts and 64 without. After a median follow-up of 3.3 years, 94 patients (84%) remained in remission. In multivariate Cox regression analysis, remission was unrelated to PJI localization, pathogens, number of surgical lavages, duration of total antibiotic treatment or intravenous therapy, choice of antibiotic agents, immune-suppression, or age. In contrast, the exchange of mobile parts was protective (hazard ratio 1.9; 95% confidence interval 1.2–2.9). Conclusions: In our retrospective single-center cohort, changing mobile parts of PJI during the DAIR approach almost doubled the probability for long-term remission.

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

“…The adherence to this strict surgical protocol throughout the six-year study in eight study centers is questionable, as inclusion in the study took place most likely only after identification of the causing pathogen. Exchange of mobile parts being a proxy for a thorough debridement was shown to be among most relevant factors for successful outcome in several previous studies in case of retained infected prosthesis [36,[53][54][55]. Noteworthy, no dropouts due to deviating surgical treatment were reported.…”

Risk factors affect success rate of debridement, antibiotics and implant retention (DAIR) in periprosthetic joint infection

“…A voluminous literature discussed the relationship between single or multiple debridement and the success rate of DAIR. Some scholars reported that multiple debridement was related to the increased failure rate of DAIR [42,[47][48][49][50]. Estes et al [47] reported that 18 of 20 PJI patients utilizing a two-stage debridement technique with the implantation of antibiotic cement beads in stage one achieved a satisfactory outcome.…”

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

“…We retrieved twenty well documented articles reporting (more than) ten own DAIR cases, and that equally display information about mobile parts' exchanges 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . All were retrospective analyses with a similar case-control design, but with different outcomes.…”

“…Importantly, none of the studies reported an adverse event related to the mobile parts' exchange, but adverse events of the mobile part's exchange have never been the primary study objectives. One retrospective study looked for antibiotic-related adverse events in curative DAIR patients, and found no specific variations according the various substrata of the DAIR population 18 . Also, we lack information regarding other clinically important noninfectious outcomes (e.g.…”