The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement – a literature review

Abstract

Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) and third most common cause of revision of TKA with significant morbidity and surgical challenges. Treatment options include non-operative measures with long term antibiotic suppression, debridement and implant retention (DAIR), one- or two-stage revision arthroplasty, arthrodesis and amputation. Implant retention without infection is ideal and DAIR has been reported to have variable success rates depending on patient factors, duration of infection, infecting micro-organisms, choice of procedure, single or multiple debridement procedures, arthroscopic or open, antibiotic choice and duration of antibiotic use. We present a thorough literature review of DAIR for infected TKA. The important factors contributing to failure are presence of sinus, immunocompromised patient, delay between onset of infection and debridement procedure, Staphylococcal infection in particular Meticillin Resistant Staphylococcal aureus, multiple debridement procedures, retention of exchangeable components and short antibiotic duration. In conclusion DAIR can be successful procedure to eradicate infection in TKA in selective patients with factors contributing to failure taken into account.

Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection

“…However, the efficacy of DAIR remains unclear, as the literature has demonstrated variable success rates, ranging from 26% to 92%. Several risk factors have been proposed to affect the outcomes of DAIR, including patient age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus (DM), rheumatoid arthritis, and steroid therapy. In addition, the roles of the optimal timing of DAIR treatment, antibiotic regimens, the involved microorganism, and the decision of whether to exchange the polyliner are still unclear.…”

Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes

“…(20,25) The DAIR approach has been recommended for the treatment of early PJIs. (26)(27)(28)(29) Despite published evidence and guidelines on the treatment of PJI using DAIR, its role and appropriateness in the treatment of PJI still remain controversial, as the evidence and recommendations are mostly based on non-randomised observational studies, case series, and/or expert opinion. Infection control rates of DAIR for hip and knee PJI varies in the literature and have been reported to range from as low as 0%…”

Indications and Limitations of Phage Therapy in Human Medicine: Personal Experience and Literature Review

“…While bacteriophages for these bacteria exist or can be easily isolated [90], they are still of little interest because of the limited failure rate of conventional treatments. In deep-seated local infections surgical debridement [91] is a preferred prerequisite before treatment with either antibiotic or phage therapy, especially in S. aureus [92] or Propionibacterium sp. [93] infections on implants.…”