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Irrigation and Debridement With Implant Retention: Does Chronicity of Symptoms Matter?
T David Tarity1, Ioannis Gkiatas1, Allina A Nocon1
1Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY.
Background:
Periprosthetic joint infection (PJI) remains a rare, yet devastating complication of total joint arthroplasty (TJA). Chronic infection is generally considered a contraindication to debridement, antibiotics, and implant retention (DAIR); however, outcomes stratified by chronicity have not been well documented.
Methods:
A retrospective review of all DAIR cases performed at a single institution from 2008 to 2015 was performed. Chronicity of PJI was categorized as acute postoperative, chronic, or acute hematogenous. Failure after DAIR, defined as re-revision for infection recurrence with the same organism, was evaluated between the 3 chronicity groups at 90 days as well as at a minimum 2-year follow-up.
Results:
Overall, 248 patients undergoing DAIR for total hip arthroplasty or total knee arthroplasty PJI were included. Categorization of PJI was acute (acute postoperative) in 59 cases (24%), chronic in 54 (22%), and acute hematogenous in 135 (54%). DAIR survivorship was 47% (range 0.3-10 years). Overall, there were 118 (47.6%) treatment failures after DAIR with a minimum of 2-year follow-up. There was no difference in failure rate between total hip or total knee arthroplasty patients (P = .07). Patients infected with Staphylococcus conferred a higher risk of failure for all DAIR procedures regardless of chronicity category.
Conclusion:
Identification of microbial species prior to undertaking DAIR may be more clinically relevant than stratification according to chronicity category when considering treatment options.
Insights
Debridement, antibiotics, and implant retention (DAIR) for periprosthetic joint infection (PJI) has a 47% failure rate. Staphylococcus infections significantly increase failure risk, suggesting microbial identification is key for successful PJI treatment.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Arthroplasty complications
Background:
- Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA).
- Chronic PJI is typically a contraindication for debridement, antibiotics, and implant retention (DAIR).
- Outcomes of DAIR based on infection chronicity are not well-documented.
Purpose of the Study:
- To evaluate the success of DAIR in treating PJI.
- To compare DAIR outcomes across different PJI chronicity categories (acute postoperative, chronic, acute hematogenous).
- To identify factors influencing DAIR failure rates.
Main Methods:
- Retrospective review of 248 DAIR cases for hip or knee PJI (2008-2015).
- PJI chronicity categorized as acute postoperative, chronic, or acute hematogenous.
- Failure defined as re-revision for infection recurrence; evaluated at 90 days and minimum 2-year follow-up.
Main Results:
- Overall DAIR survivorship was 47%, with 47.6% treatment failures at minimum 2-year follow-up.
- No significant difference in failure rates between total hip and total knee arthroplasty.
- Infection with Staphylococcus species significantly increased the risk of DAIR failure, irrespective of PJI chronicity.
Conclusions:
- Microbial species identification is more critical than infection chronicity for guiding DAIR treatment decisions in PJI.
- Staphylococcus infections pose a higher risk for DAIR failure.
- Further research into pathogen-specific treatment strategies for PJI is warranted.
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