Abstract
Purpose: Debridement, antibiotics, and implant retention (DAIR) is an established treatment modality in periprosthetic joint infections (PJIs), but success rates vary. This study compared the success of DAIR for PJIs after a total hip arthroplasty (THA), with or without local antibiotic delivery with CaSO as the carrier material. Methods: A retrospective review of DAIR for PJIs after THA performed between 2010 and 2018, including 41 patients is conducted. A total of 27 patients were treated by DAIR with local antibiotics with CaSO as the carrier material, and 14 patients were treated by a standard DAIR. The endpoints were treatment failure, defined as the need for a reoperation, either a second DAIR or a prosthesis removal or exchange due to persistent or recurrent infection, the initiation of a long-term suppressive antibiotic treatment, or death related to infection. Results: Considering any reoperation as an outcome, 11 of 14 cases treated without AB-CaSO (79 %) and 4 of the 27 cases treated with AB-CaSO failed (15 %). Considering revision as an outcome, 9 out of 14 cases treated without AB-CaSO (64 %) and 4 of the 27 cases treated with AB-CaSO (15 %) failed. A Kaplan–Meier survival analysis showed that local antibiotic delivery with CaSO as the carrier material led to a significantly longer infection-free survival, considering any surgical revision (; hazard ratio 8.9 (95 % CI 2.8–28.2)) or revision with component exchange (; hazard ratio 5.6 (95 % CI 1.7–18.2)) as the endpoint. Conclusion: The addition of local antibiotics with CaSO as the carrier material to DAIR for PJIs after THA significantly increases success rates, such as infection-free survival, any reoperation, and revision with component exchange in particular.
Highlights
Periprosthetic joint infection (PJI) has an incidence of approximately 1 % after total hip arthroplasty (THA) and 2 % after total knee arthroplasty (TKA) in large register-based studies (Kurtz et al, 2010; Gundtoft et al, 2015; Huotari et al, 2015)
The functional outcomes of successful DAIR correspond to results obtained after primary THA or TKA without PJI (Barros et al, 2019), which are much better than the functional outcomes after two-stage exchange (Dzaja et al, 2015; Grammatopoulos et al, 2017a; Herman et al, 2017)
Among the 41 patients treated using the DAIR procedure for PJI after THA with standard implants used for primary operations, 14 were treated between 2010 and 2017 without local application of antibiotics, and 27 were treated between 2015 and 2018 with AB-CaSO4
Summary
Periprosthetic joint infection (PJI) has an incidence of approximately 1 % after total hip arthroplasty (THA) and 2 % after total knee arthroplasty (TKA) in large register-based studies (Kurtz et al, 2010; Gundtoft et al, 2015; Huotari et al, 2015). While being very successful regarding the eradication of infection, this option is associated with functional outcomes that are worse (Oussedik et al, 2010; Dzaja et al, 2015; Grammatopoulos et al, 2017a, b; Herman et al, 2017), with higher complications and increased mortality rates compared to implant-retaining procedures and one-stage exchange The functional outcomes of successful DAIR correspond to results obtained after primary THA or TKA without PJI (Barros et al, 2019), which are much better than the functional outcomes after two-stage exchange (Dzaja et al, 2015; Grammatopoulos et al, 2017a; Herman et al, 2017)
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