Debridement, Antibiotics and Implant Retention for Early Periprosthetic Infections of the Hip: Outcomes and Influencing Factors

Abstract

Purpose Debridement, antibiotics and implant retention (DAIR) is commonly performed and widely accepted for the treatment of acute infections following hip arthroplasty. The aims of this study were to: i) determine the DAIR success rate in treating acute postoperative and hematogenous periprosthetic infections of the hip at a tertiary hospital, ii) identify possible outcome predictors, and iii) analyze clinical and radiological outcomes. Materials and Methods We retrospectively reviewed cases of acute postoperative (≤3 months from index procedure) and hematogenous periprosthetic infections following total hip arthroplasty treated with DAIR at our hospital between 2004 and 2015. Overall, 26 hips (25 patients) were included in the study, with a mean age of 72.5 years (standard deviation [SD], 9.4). The mean follow-up was 48.5 months (SD, 43.7). Several variables (e.g., patient characteristics, infection type, surgery parameters) were examined to evaluate their influence on outcomes; functional and radiographic outcomes were assessed. Results The overall success rate of DAIR was 26.9%. The male sex was associated with treatment failure ( P =0.005) and debridement performed by a surgeon in hip unit with success ( P =0.028). DAIR failure increased in patients with chronic pulmonary disease ( P =0.059) and steroid therapy ( P =0.062). Symptom duration of <11 days until DAIR yielded a better infection eradication rate ( P =0.068). The mean postoperative Harris Hip Score was 74.2 (SD, 16.6). Conclusion DAIR, despite being used frequently, had a high failure rate in our series. Outcomes improved if an experienced hip arthroplasty surgeon performed the surgery. Patient comorbidities and symptom duration should be considered for decision-making.

The Use of Calcium Sulphate beads in Periprosthetic Joint Infection, a systematic review

“…Comparing these to Iza et al results (23), who reported on 22 knees with PJI underwent DAIR only with an overall success rate of 77%, will make it unsatisfactory. However, Flierl et al results are significantly better when compared to Uriarte et al (24) who reported on 26 hips with PJI underwent DAIR only procedure with an overall success rate of 26.9%. A literature review by Tsang et al (25), included 1296 patients who underwent DAIR for the management of PJI in hip arthroplasty, concluded that the only determinants of outcome is the timing of DAIR after the onset of symptoms of infection.…”

Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention

“…Uriarte et al reported a significantly higher failure rate when DAIR was performed by general orthopaedic surgeons compared with hip surgeons 25 . Experience was not considered in the current study.…”

A review of current practices in periprosthetic joint infection debridement and revision arthroplasty

“…As previously mentioned, the treatment success rate of DAIR is highly variable, ranging from approximately 30% to 90% efficacy [83,[116][117][118]. One factor not previously discussed that can determine the success of a DAIR procedure is early intervention [100].…”