DAIR (Debridement, Antibiotics, and Implant Retention) for the Treatment of Periprosthetic Joint Infection of Knee

Budhiparama, Nicolaas C.; Santoso, Asep; Hidayat, Hendy; Ifran, Nadia Nastassia

doi:10.1007/978-3-030-81553-0_15

Cited by 1 publication

(2 citation statements)

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“…On the other side, Lizaur-Utrilla et al [31] showed a negative impact of prior failed DAIRs on the functional outcome of subsequent two-stage revisions. The failure of the DAIR procedure has been related [32] to multiple factors such as host-related factors (rheumatoid arthritis, old age, male sex, chronic renal failure, liver cirrhosis, and chronic obstructive pulmonary disease); implant-related factors (fracture as indication for the original surgery, cemented implants); factors related to severity of the infection (high serological CRP, a high bacterial inoculum, presence of bacteremia); and finally, causative micro-organisms (S. aureus and Enterococci).…”

Section: Discussionmentioning

confidence: 99%

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Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series

et al. 2023

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Introduction: Periprosthetic joint infections (PJI) represent a devastating consequence following total joint arthroplasty (TJA). In this study, the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure (DAIR) to improve the possibilities of retaining an acutely infected TJA. Materials and Methods: This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads in a setting of acute (<4 weeks from symptoms onset) PJI with pathogen identification. The combination of three different surgical techniques (tumor-like synovectomy, argon beam/acetic acid application and chlorhexidine gluconate brushing) aims to remove the bacterial biofilm from the implant without explanting the original hardware. Results: In total, 62 patients met the acute infection criteria (<4 weeks of symptoms); there were 57 males and five females. The patients’ average age at the time of treatment was 71 years (62–77) and the average BMI was 37 kg/m2. The micro-organism, always identified through synovial fluid analysis (culture, multiplex PCR or Next Generation Sequencing), was an aerobic Gram + in 76% (S. Coag-Neg 41%; S. aureus 16%), Gram—in 10% (E. coli 4%) and anaerobic Gram + in 4%. The DAPRI treatment was performed at an average of 3 days from symptoms onset (1–7 days). All patients underwent a 12-week course of post-operative antibiotic therapy (6 weeks I.V. and 6 weeks oral). All patients were available at the 2-year minimum FU (24–84 months). A total of 48 (77.5%) patients were infection-free at the final FU, while 14 patients underwent 2-stage revision for PJI recurrence. In total, four patients (6.4%) had a prolonged drainage from the wound after placement of the calcium sulphate beads. Conclusions: This study suggests that the DAPRI technique could represent a valid alternative to the classic DAIR procedure. The current authors do not recommend this procedure outside of the main inclusive criteria (acute scenario micro-organism identification).

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Section: Discussionmentioning

confidence: 99%

“…They were 57 males and 5 females. The patients' average age at the time of treatment was 71 years (62-77) and the average BMI was 37 (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) kg/m 2 . The original total joint arthroplasty surgery is shown in Table 1.…”

Section: Study Populationmentioning

confidence: 99%