Abstract
The most preferred treatment for acute periprosthetic joint infection (PJI) is surgical debridement, antibiotics and retention of the implant (DAIR). The reported success of DAIR varies greatly and depends on a complex interplay of several host-related factors, duration of symptoms, the microorganism(s) causing the infection, its susceptibility to antibiotics and many others. Thus, there is a great clinical need to predict failure of the “classical” DAIR procedure so that this surgical option is offered to those most likely to succeed, but also to identify those patients who may benefit from more intensified antibiotic treatment regimens or new and innovative treatment strategies. In this review article, the current recommendations for DAIR will be discussed, a summary of independent risk factors for DAIR failure will be provided and the advantages and limitations of the clinical use of preoperative risk scores in early acute (post-surgical) and late acute (hematogenous) PJIs will be presented. In addition, the potential of implementing machine learning (artificial intelligence) in identifying patients who are at highest risk for failure of DAIR will be addressed. The ultimate goal is to maximally tailor and individualize treatment strategies and to avoid treatment generalization.
Highlights
Success rates of the “classical” debridement, antibiotics, irrigation and implant retention (DAIR) for acute periprosthetic joint infections (PJI) vary widely, ranging from 30 to 90% [1,2,3,4,5]
Since many different factors have been identified in literature as independent predictors for DAIR failure (Table 1) [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25], it is a great challenge to select those patients who are the best candidates for DAIR
To identify patients who are likely to fail DAIR, two preoperative risk scores have been proposed in literature; one for early acute and one for late acute PJIs [8, 16]
Summary
Success rates of the “classical” debridement, antibiotics, irrigation and implant retention (DAIR) for acute periprosthetic joint infections (PJI) vary widely, ranging from 30 to 90% [1,2,3,4,5]. Apart from a thorough surgical debridement with exchange of modular components, many factors contribute to the success of DAIR; that includes shorter duration of symptoms, lack of patient comorbidities, a low bacterial inoculum and/or degree of inflammation at clinical presentation, a causative microorganism that is susceptible to antibiotics with anti-biofilm properties and many others [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. As the microorganism and its susceptibility to antibiotics is often not known prior to surgery, these implant- and host-related factors are of utmost importance to take into consideration
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