Abstract
Background: Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). The inflammation caused by the infection and the surgical intervention during DAIR may influence the long-term stability of the implant. In this study, we analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection.Methods: Total hip arthroplasties (THAs) from our database implanted between 1992 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome was implant failure over time. It was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening.Results: 57 THAs (56 patients) were included in the DAIR cohort and 170 THAs (168 patients) in the control cohort. The mean follow-up periods in the DAIR and control cohorts were 6.1 and 7.8 years, respectively. During follow-up, 20 (36%) patients in the DAIR cohort and 54 (32%) in the control cohort died after a mean of 4.1 and 7.2 years, respectively. Revision for any reason was performed in 9 (16%) THAs in the DAIR cohort and in 10 (6%) THAs (p=0.03) in the control cohort, and revision for aseptic loosening of any component in 5 (9%) and 8 (5%) THAs (p=0.32), respectively. Radiological analysis included 56 THAs in the DAIR cohort and 168 THAs in the control cohort. Two (4%) stems and 2 (4%) cups in the DAIR cohort and 7 (4%) and 1 (0.6%) in the control cohort, respectively, demonstrated radiological signs of failure (p=1).Conclusions: THAs exposed to DAIR were revised for any reason more frequently than were THAs in the control cohort. The difference was mainly caused by septic failures. After cure of PJI, the difference in revisions for aseptic loosening was not significant. There was no significant difference in radiographic evidence of loosening of any component between cohorts. These data suggest that cured hip PJI previously exposed to DAIR do not fail more frequently for aseptic reasons than do THAs not exposed to DAIR.
Highlights
The number of arthroplasty procedures being performed is increasing over time
We identified 62 Total hip arthroplasties (THAs) exposed to DAIR with a curative intention because of periprosthetic joint infection (PJI)
56 (29 female and 27 male) patients with DAIR in 57 THAs were included in the DAIR cohort
Summary
The number of arthroplasty procedures being performed is increasing over time. It is estimated that, by 2030, more than 570,000 primary total hip arthroplasties (THAs) will be performed in the UnitedStates annually [1]. By 2030, more than 570,000 primary total hip arthroplasties (THAs) will be performed in the United. The estimated rate of periprosthetic joint infection (PJI) of the hip is approximately 1% [2]. Zimmerli et al [3] and the Infectious Diseases Society of America [4] published a treatment algorithm for the management of PJI. It consists of debridement, antibiotics and implant retention (DAIR) or 1- or 2-stage exchange of the arthroplasty as curative surgical strategies to preserve a functional joint. Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). We analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection
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