Late Acute Hematogenous Infection Following Total Knee Arthroplasty: Debridement, Antibiotics and Implant Retention (DAIR), One-Stage Revision or Two-Stage Revision?

Rodríguez-Merchán, E. Carlos; Encinas-Ullán, Carlos A.; Ruiz-Pérez, Juan S.; Gómez-Cardero, Primitivo

doi:10.1007/978-3-030-80695-8_13

Cited by 1 publication

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“…This same study showed a higher rate of failure in male sex as well. Chronic renal failure [ 57 , 59 , 63 ], liver cirrhosis [ 63 , 64 ], and chronic obstructive pulmonary disease [ 65 ] are also associated with higher rates of failure. Naturally, given the relative immunocompromising nature of these co-morbidities, it makes intuitive sense that individuals with these conditions would be at a higher risk of failure.…”

Section: Discussionmentioning

confidence: 99%

Principles of mechanical and chemical debridement with implant retention

et al. 2023

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Background Periprosthetic joint infection (PJI) is one of the most common causes of early revision for total hip and knee arthroplasty. Mechanical and chemical debridement typically referred to as debridement, antibiotics, and implant retention (DAIR) can be a successful technique to eradicate PJI in acute postoperative or acute hematogenous infections. This review will focus specifically on the indications, techniques, and outcomes of DAIR. Discussion The success of mechanical and chemical debridement, or a DAIR operation, is reliant on a combination of appropriate patient selection and meticulous technique. There are many technical considerations to take into consideration. One of the most important factors in the success of the DAIR procedure is the adequacy of mechanical debridement. Techniques are surgeon-specific and perhaps contribute to the large variability in the literature on the success of DAIR. Factors that have been shown to be associated with success include the exchange of modular components, performing the procedure within seven days or less of symptom onset, and possibly adjunctive rifampin or fluoroquinolone therapy, though this remains controversial. Factors that have been associated with failure include rheumatoid arthritis, age greater than 80 years, male sex, chronic renal failure, liver cirrhosis, and chronic obstructive pulmonary disease. Conclusions DAIR is an effective treatment option for the management of an acute postoperative or hematogenous PJI in the appropriately selected patient with well-fixed implants.

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