Abstract
Background: The management of prosthetic joint infections (PJI) with debridement and retention of the implant (DAIR) has its rules. Some authors claim that lacking the exchange of mobile prosthetic parts is doomed to failure, while others regard it as optional. Methods: Single-center retrospective cohort in PJIs treated with DAIR. Results: We included 112 PJIs (69 total hip arthroplasties, 9 medullary hip prostheses, 41 total knee arthroplasties, and 1 total shoulder arthroplasty) in 112 patients (median age 75 years, 52 females (46%), 31 (28%) immune-suppressed) and performed a DAIR procedure in all cases—48 (43%) with exchange of mobile parts and 64 without. After a median follow-up of 3.3 years, 94 patients (84%) remained in remission. In multivariate Cox regression analysis, remission was unrelated to PJI localization, pathogens, number of surgical lavages, duration of total antibiotic treatment or intravenous therapy, choice of antibiotic agents, immune-suppression, or age. In contrast, the exchange of mobile parts was protective (hazard ratio 1.9; 95% confidence interval 1.2–2.9). Conclusions: In our retrospective single-center cohort, changing mobile parts of PJI during the DAIR approach almost doubled the probability for long-term remission.
Highlights
Prosthetic joint infection (PJI) management requires both surgery and antimicrobial therapy
We reported the prosthetic joint infections (PJI) definition in prior publications [1,11,12], which are based on the Infectious Diseases Society of America (IDSA) definitions [13]
We introduced independent variables known to be associated with a poor DAIR prognosis into the multivariate analysis, except for surgical interventions and antibiotic treatment, which we automatically included into the final model
Summary
Prosthetic joint infection (PJI) management requires both surgery and antimicrobial therapy. For curative DAIR, literature is sparse regarding the number of surgical lavages needed [3] and the scientific proof for the recommended exchange of mobile parts (polyethylene, liners) [4]. These are important questions, because the consequences may lead to added expenses, prolongation of surgery ( potentially enhancing surgical site infections [5]), and increased morbidity [4]. The management of prosthetic joint infections (PJI) with debridement and retention of the implant (DAIR) has its rules. Conclusions: In our retrospective single-center cohort, changing mobile parts of PJI during the DAIR approach almost doubled the probability for long-term remission
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