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Redo DAIR: The Game Is Seldom Worth the Candle
Ignacio Sancho1,2,3, Iñaki Otermin-Maya4, Jorge Gutiérrez-Dubois4
1Department of Orthopaedics and Trauma Surgery, Hospital Reina Sofía, 31500 Tudela, Spain.
Antibiotics (Basel, Switzerland)
|January 21, 2023
Summary
A second debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections has a very low success rate. If the first DAIR fails, component removal is recommended over a repeat procedure.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Prosthetic joint infections (PJIs) pose a significant challenge in orthopedic surgery.
- Debridement, antibiotics, and implant retention (DAIR) is a common treatment for acute PJIs, but outcomes can be inconsistent.
- The efficacy and prognosis of a second DAIR procedure following a failed initial attempt are poorly understood and debated.
Purpose of the Study:
- To evaluate the success rate and outcomes of a second DAIR procedure in cases of acute prosthetic joint infection where the initial DAIR failed.
- To compare the outcomes of a second DAIR with the initial DAIR procedure.
- To determine the ultimate prognosis for patients undergoing a second DAIR after a failed first attempt.
Main Methods:
- Retrospective analysis of 84 cases of acute prosthetic hip and knee joint infections treated with DAIR between 2011 and 2020.
- Identification of cases (12) where the initial DAIR procedure failed and a second DAIR was subsequently performed.
- Comparison of success rates and ultimate patient outcomes between the first and second DAIR procedures.
Main Results:
- The success rate of a second DAIR procedure was significantly lower (8%) compared to the initial DAIR (57%).
- In cases where the second DAIR also failed, infection eradication was not achieved in any patients.
- The ultimate prognosis following a second failed DAIR was consistently unfavorable.
Conclusions:
- A second DAIR procedure for acute prosthetic joint infections after a failed initial attempt has a low probability of success.
- Given the high failure rate and poor ultimate outcomes, revision surgery involving component removal should be strongly considered instead of a second DAIR.
- This study suggests a paradigm shift in managing failed DAIR for acute PJIs, favoring explantation over re-debridement.
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