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Debridement, Antibiotics, and Implant Retention with the Direct Anterior Approach for Acute Periprosthetic Joint
R L Deijkers1, E P M van Elzakker1, B G Pijls1
1Departments of Orthopaedic Surgery (R.L.D. and B.G.P.) and Microbiology (E.P.M.v.E.), Haga Hospital, The Hague, the Netherlands.
Background:
Periprosthetic joint infection (PJI) is a devastating complication following total hip replacement. The direct anterior approach for total hip replacement is becoming increasingly popular. However, little is known about the success rate of treatment with debridement, antibiotics, and implant retention (DAIR) using the direct anterior approach. The aim of this study was to analyze the effectiveness of DAIR using this approach and identify patient and surgical factors that influence the results.
Methods:
Seventy-four patients (75 hips) in whom DAIR had been performed were identified from the records of the weekly multidisciplinary infection meeting and the laboratory information management systems. In 4% (3 hips), modular components were exchanged. To consider competing risks (death), we used competing risk models.
Results:
The competing risk analysis showed a successful outcome after DAIR of 82% at 4 years of follow-up; this rate was 89% at 4 years follow-up when excluding patients managed with gentamicin beads. The sensitivity analysis revealed that obesity (body mass index [BMI] of ≥30 kg/m2), use of gentamicin beads, and an erythrocyte sedimentation rate (ESR) of >40 mm/hr increased the risk of failure.
Conclusions:
DAIR using the direct anterior approach without the routine exchange of modular components offers a success rate that is comparable with other approaches for eradicating acute PJI following primary hip arthroplasty.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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