Dual Surgical Setup May Improve Infection Control Rate of Debridement and Implant Retention Procedures for Periprosthetic Infections of the Hip and Knee

Abstract

BackgroundDebridement, antibiotics, and implant retention (DAIR) is an appealing treatment option for periprosthetic joint infection (PJI) due to its low cost and low morbidity. There are many nonmodifiable risk factors for DAIR failure that have previously been established. A dual DAIR setup constitutes establishing a new, sterile field after the initial debridement. The purpose of this study is to determine whether the modifiable surgical technique of a dual setup improves the infection control rate following PJI. MethodsA retrospective study was conducted from January 1, 2000 to December 31, 2017 to identify patients who underwent a DAIR procedure as initial surgical treatment for PJI of the hip or knee. Patients were divided between 2 groups, failed and successful DAIR procedures. Failure was defined as infection recurrence requiring surgical intervention. Demographic (age, gender, body mass index, smoking status, American Society of Anesthesiologists status), preoperative comorbidity (hypertension, cardiac disease, diabetes status, depression or anxiety diagnosis, pulmonary disease), operating surgeon, single vs dual setup, hospital, use of long-term antibiotics postoperatively (greater than 6 weeks of intravenous antibiotics), joint, and laterality data were compared between cohorts using multivariate regression analysis. ResultsTwo hundred sixty-three patients were identified who underwent DAIR as the exclusive and initial treatment for PJI. Single vs dual setup, knee vs hip joint, cardiac or vascular disease diagnosis, major depressive disorder or generalized anxiety disorder diagnosis, and staphylococcal infections were found to be independent predictive variables for DAIR failure. ConclusionIn our series, the dual setup DAIR was a modifiable surgical technique that significantly decreased the risk of infection recurrence compared to single setup DAIR.