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Acute periprosthetic knee infection: is there still a role for DAIR?
Paolo Di Benedetto1, Enrico Daniele Di Benedetto, Daniele Salviato
1. paolo.dibenedetto@asuiud.sanita.fvg.it.
Background And Aim Of The Work:
Periprosthetic knee infection is a rare complication associated with prosthetic failure; incidence change from 0,4-2% of primary total knee replacement and 5.6% in revisions. Indications for debridment, antibiotics and implant retention (DAIR) are early acute infections or acute delayed infection. Aim of the work is to check if this technique is still a successful in early infections.
Methods:
We have analyzed recent literature data on DAIR and all DAIR procedures in our clinic in the last 10 years, the mean time between onset of symptoms and surgery, the mean antibiotic therapy duration and results we have obtained. We evaluate the diagnostic process and different treatments in early knee periprosthetic infections, especially the DAIR approach.
Results:
If correct indications are followed, DAIR has a success rate in 31-100% of the cases; if it is applied in late chronic infection the success rate is 28-62%. In our experience DAIR has an 80% success rate: in 20 patients treated with DAIR we had 4 failures.
Conclusions:
DAIR can be considered a successful treatment, but it depends from individual patient factors, from the microorganisms involved, from the duration of antibiotic therapy and from correct choice in timing and in execution of DAIR by the orthopedic surgeon.
Insights
Debridement, antibiotics, and implant retention (DAIR) is a successful treatment for early periprosthetic knee infections, achieving an 80% success rate in our study. Proper patient selection and surgical timing are crucial for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic knee infection is a rare but serious complication following knee replacement surgery.
- Incidence rates range from 0.4-2% for primary total knee replacement and 5.6% for revisions.
- Debridement, antibiotics, and implant retention (DAIR) is indicated for early acute or acute delayed infections.
Purpose of the Study:
- To evaluate the success rate of the debridement, antibiotics, and implant retention (DAIR) technique in treating early periprosthetic knee infections.
- To assess the diagnostic process and treatment outcomes for early knee periprosthetic infections, focusing on the DAIR approach.
Main Methods:
- Analysis of recent literature data on DAIR procedures.
- Review of all DAIR procedures performed at the clinic over the last 10 years.
- Evaluation of mean time from symptom onset to surgery and mean antibiotic therapy duration.
Main Results:
- DAIR success rates range from 31-100% when indications are correctly followed, versus 28-62% for late chronic infections.
- The study achieved an 80% success rate with DAIR, with 4 failures in 20 treated patients.
- Key factors influencing success include patient-specific conditions, microbial agents, and antibiotic therapy duration.
Conclusions:
- DAIR is a successful treatment option for early periprosthetic knee infections.
- Treatment success is contingent upon appropriate patient selection, timely surgical intervention, and effective antibiotic management.
- Orthopedic surgeons must carefully consider individual patient factors and microbiological data for optimal DAIR execution.
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