Debridement, Antibiotics, Irrigation, and Retention (DAIR) of the Prosthesis after Hip Hemiarthroplasty Infections. Does it Work?

Kazımoğlu, Cemal; Yalçın, Necati; Önvural, Burak; Akçay, Serkan; Ağuş, Haluk

doi:10.5301/ijao.5000430

Cited by 15 publications

(19 citation statements)

References 24 publications

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“…Blomfeldt et al [33] reported unfavorable outcomes in hip fracture patients with 82% conversion to excision arthroplasty. Kazimoglu et al [34] reported a DAIR treatment success rate of 41% in a multicenter retrospective study of 39 patients, and similarly, Guren et al [10] reported a success rate of 43% in a singlecenter retrospective study of 35 patients. Additionally, studies have reported increased failure rates arthroplasty for hip fracture compared with elective arthroplasty; Bergkvist et al [21] reported 35% increased failure rate, De Vries et al [35], 23%, and Del Toro et al [36], 21%.…”

Section: Discussionmentioning

confidence: 91%

Early Peri-Prosthetic Joint Infection after Hemiarthroplasty for Hip Fracture: Outcomes of Debridement, Antibiotics, and Implant Retention

Yassin

Sharma

Butt

et al. 2020

Surgical Infections

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Section: Discussionmentioning

confidence: 91%

Early Peri-Prosthetic Joint Infection after Hemiarthroplasty for Hip Fracture: Outcomes of Debridement, Antibiotics, and Implant Retention

Yassin

Sharma

Butt

et al. 2020

Surgical Infections

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“…In a recent study, Kazimoglou et al [15] reported a limited success rate (41%) for the DAIR procedure for the treatment of seven patients with early-onset hemiarthroplasty infections caused by either gram-positive or gram-negative bacteria. They also found that successful outcomes are positively correlated with a duration of the infection after implantation under two weeks and a sedimentation value lower than 60 mm/h.…”

Section: Discussionmentioning

confidence: 99%

Acute Periprosthetic Hip Joint Infection Caused by Multidrug-Resistant Acinetobacter Baumannii: Is Debridement, Antibiotics, Irrigation, and Implant Retention a Viable Treatment Option?

Vasiliadis

Poutoglidou

Chatziravdeli

et al. 2021

Cureus

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In this study, we aimed to investigate the effectiveness of debridement, antibiotics, irrigation, and implant retention (DAIR) in periprosthetic hip joint infection caused by multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii) . From July 2019 to June 2020, we retrospectively reviewed all patients treated for periprosthetic hip joint infections caused by MDR A. baumannii at our institution. The diagnosis of periprosthetic joint infection (PJI) was established based on the Musculoskeletal Infection Society (MSIS) 2018 criteria. The Charlson Comorbidity Index (CCI) was used to estimate the risk of mortality. The patients were followed up for over a year, until their death, or loss to follow-up. Four patients (three females and one male), with a mean age of 68 years, were included in the study. A. baumannii exhibited resistance to fluoroquinolones in all cases. All patients were treated with the DAIR procedure followed by intravenous tigecycline and colistin combination treatment. Prosthesis retention with good functional results was achieved in two patients. One patient required resection arthroplasty and one patient died two months after the initial surgical treatment, yielding a success rate of 50% for the DAIR procedure. Periprosthetic hip joint infection caused by MDR A. baumannii is one of the most demanding and challenging complications in orthopaedic practice. This case series suggests that the outcome of the DAIR is affected by a number of factors that are in a complex interplay. Our results indicate a limited success rate for the DAIR procedure in the treatment of a periprosthetic hip joint infection caused by MDR A. baumannii .

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“…However, the success in controlling the infection varies from 31% to 100%. 13,[14][15][16][17] Although the term DAIR is not used in megaprosthesis infection papers, the outcome of debridement and implant retention in this group of patients has been very poor. Jeys et al reported that there were 68 patients of 136 patients treated with local debridement.…”

Section: Discussionmentioning

confidence: 99%

“…We left the cartilage untouched as in Kazimoglu et al's report. 15 We deliberately changed the bipolar hip component into a total hip component in order to leave a big piece of 6…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-laden cement wrap: A simple but effective way of treating patients with megaprosthesis infection

Lam

Yau

et al. 2019

J Orthop Surg (Hong Kong)

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Infection is one of the commonest causes for megaprosthesis failure. The current treatment includes antibiotics but no surgery, debridement, prosthesis removal and joint fusion, prosthesis revision or amputation. Success in controlling infection may be less than 50% in implant revision. The overall risk of amputation is more than 20%. We believe that repeated debridement with antibiotic-laden cement wrap (ALCW) may be a reliable alternative for managing the megaprosthesis infection. The purposes of this article are to identify whether ALCW is an effective way of eradicating the megaprosthesis infection, the associated complications and the functional outcome after management by ALCW. Methods: This was a retrospective study of patients with megaprosthesis infection. From January 2014 to June 2016, there were five patients with tumour megaprosthesis infection who had undergone the ALCW procedure. Ages ranged from 17 to 59 years of age. Male to female ratio was 4:1. The patients studied had humeral (1), proximal femoral (1), distal femoral (1) and proximal tibial (2) prostheses. All patients had follow-ups more than 1 year (21-52 months) after treatment. Results: All patients recovered from their implant infection and the implants were retained in all patients. There was no sign of infection in the most recent follow-up. One patient died of osteosarcoma recurrence. One patient had a large block of cement causing plastic insert dislodgement in the shoulder joint 1 year after surgery. Another patient with a dislocated hip cup had revision carried out in the final debridement. The most recent Musculoskeletal Tumor society (MSTS) scores ranged from 21 to 30. All patients were satisfied with their treatment. Conclusions: In this preliminary report of a small number of patients, ALCW has achieved 100% infection control. ALCW may be an easy and effective alternative for managing the megasprosthesis infection. The complications associated can be avoidable. The functional outcome is excellent.

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Debridement, Antibiotics, Irrigation, and Retention (DAIR) of the Prosthesis after Hip Hemiarthroplasty Infections. Does it Work?

Abstract: Our results indicated limited success to DAIR- treated patients with infected HA. The high failure rate of DAIR treatment after 2 weeks from the implantation should be taken into consideration.

Cited by 15 publications

References 24 publications

Early Peri-Prosthetic Joint Infection after Hemiarthroplasty for Hip Fracture: Outcomes of Debridement, Antibiotics, and Implant Retention

Early Peri-Prosthetic Joint Infection after Hemiarthroplasty for Hip Fracture: Outcomes of Debridement, Antibiotics, and Implant Retention

Acute Periprosthetic Hip Joint Infection Caused by Multidrug-Resistant Acinetobacter Baumannii: Is Debridement, Antibiotics, Irrigation, and Implant Retention a Viable Treatment Option?

Antibiotic-laden cement wrap: A simple but effective way of treating patients with megaprosthesis infection

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