Abstract
PurposeThe frequency of periprosthetic knee infections increases yearly because of the popularity of the total knee prostheses. Revision knee arthroplasty is an annoying problem for both the surgeons and the patients. Debridément, antibiotics, and implant retention (DAIR) is a popular alternative for the treatment of periprosthetic knee infections. Little is known about the fate of the failed DAIR patients. This study aims to investigate the effect of the failed DAIR on the clinical result after two-staged revision arthroplasty.MethodNinety-nine two-staged revision arthroplasties and 85 DAIR patients from two reference clinics were retrospectively analyzed. The minimum follow-up was 36 months. Patients were grouped according to the treatment as, two-staged revision without DAIR, two-staged revision after failed DAIR, and successful DAIR. Their Knee Society Scores (KSS), functional KSS (KSS-f) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were analyzed and compared.ResultsDAIR has a 52.9% success rate for the treatment of infection. Elevated erythrocyte sedimentation rates and C-reactive peptide levels are not risk factors for failure, but the time passed since the index surgery is a risk factor for worse outcome scores. Failed DAIR is not a risk factor for reinfection after two-staged revision. Last KSS after failed DAIR, successful DAIR, and two-staged revision were 83.98±7.033, 91.89±4.386, and 91.38±4.735, respectively. Last KSS-f after failed DAIR, successful DAIR, and two-staged revision were 86.25±9.524, 94.56±8.106, and 94.85±5.996, respectively. Last WOMAC after failed DAIR, successful DAIR, and two-staged revision were 86.16±7.745, 94.750±4.964, and 93.319±5.961, respectively. ConclusionFailed DAIR is associated with lesser, but still good, or excellent clinical scores. DAIR is suggested as a promising treatment option for periprosthetic knee infections in well-selected patients.
Highlights
Total knee arthroplasty (TKA) is a standard surgical procedure utilized for knee arthritis, with a 1.52% prevalence in the USA [1]
Elevated erythrocyte sedimentation rates and C-reactive peptide levels are not risk factors for failure, but the time passed since the index surgery is a risk factor for worse outcome scores
Days passed since the index arthroplasty is not a significant risk factor, but days passed since the onset of symptoms is associated with failure of debridement and antibiotics with implant retention (DAIR)
Summary
Total knee arthroplasty (TKA) is a standard surgical procedure utilized for knee arthritis, with a 1.52% prevalence in the USA [1]. With the trend of increment of incidence of TKA, revision TKA (rTKA) will increase and be an economic burden for health care systems [2]. Infection is the most common reason for the failure of TKA, accounting for 25.2% of all the rTKAs [3]. Two-stage revision is the gold-standard treatment of periprosthetic joint infections (PJI). Because of the high morbidity and economic burden [2], treatment modality, which consists of debridement and antibiotics with implant retention (DAIR), is gaining popularity [4]. The main reasons for failure are highly-virulent organisms, comorbidities like chronic obstructive lung disease and diabetes mellitus, age older than 85, and DAIR performed after more than 30 days of index arthroplasty [7,8,9]
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