Abstract
Introduction: Early recognition and appropriate initial treatment with debridement, antibiotics and implant retention (DAIR) if a suspicion of an early prosthetic joint infection (PJI) is present can eradicate infection on first attempt and prevent implant failure. We evaluated the outcome after 1 year of patients treated with DAIR after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Furthermore, we determined preoperative, microbiology, and treatment factors related to failure after DAIR.Methods: A retrospective cohort study was assembled with 91 patients undergoing DAIR with a high suspicion of an early PJI. Records were reviewed for demographics, preoperative laboratory results, microbiological data, given treatment and postoperative follow-up. The primary outcome was infection-free implant survival at 1 year. Repeated DAIR was not considered as treatment failure.Results: The rate of infection-free implant survival following DAIR in a suspected early PJI was 85% (95% confidence intervals (CI) 78-91). Cultures remained negative in 20 patients, with no occurrence of infection during follow-up. A higher failure rate was seen in early PJI caused by Enterococcus faecalis (p=0.04). Multivariate analysis showed a statistically significant association between treatment failure and high C-reactive protein level (CRP >100) (odds ratio 10.0, 95% CI [1.5-70]) and multiple DAIR procedures (≥2) (odds ratio 5.0, 95%CI [1.1-23]).Conclusion: If an early PJI is suspected DAIR is the appointed treatment with up to 2 debridement procedures. Since culture-negative DAIRs were not related to any complications during follow-up, overtreatment of suspected PJI seems to do no significant harm with respect to implant failure.
Highlights
Recognition and appropriate initial treatment with debridement, antibiotics and implant retention (DAIR) if a suspicion of an early prosthetic joint infection (PJI) is present can eradicate infection on first attempt and prevent implant failure
State of the art clinical practice recommends DAIR for an early PJI, provided that the prosthesis is stable, the duration of symptoms does not exceed the length of 3 weeks, the skin and soft tissues are intact, and the causative pathogen is susceptible to a biofilm-active agent [8]
A total of 96 consecutive cases were reviewed of which 5 were excluded because follow-up after DAIR was less than 1 year
Summary
Recognition and appropriate initial treatment with debridement, antibiotics and implant retention (DAIR) if a suspicion of an early prosthetic joint infection (PJI) is present can eradicate infection on first attempt and prevent implant failure. We evaluated the outcome after 1 year of patients treated with DAIR after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Prosthetic joint infections (PJI) are the leading cause of revision in total knee arthroplasty (TKA) and the third most common cause of revision in total hip arthroplasty (THA) [1, 2]. Recognition and appropriate initial treatment is important to eradicate infection on first attempt and prevent implant failure. Infections can be eliminated with secondary prevention, through surgical debridement, antibiotic treatment, and implant retention (DAIR) [7, 8]. Failure of DAIR is related to preoperative available parameters (patient-related, symptomrelated, laboratory parameters), culture/ microorganism related factors, and treatment associated data
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