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Principles of mechanical and chemical debridement with implant retention
David G Deckey1, Zachary K Christopher1, Joshua S Bingham1
1Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ, 85054, USA.
Background:
Periprosthetic joint infection (PJI) is one of the most common causes of early revision for total hip and knee arthroplasty. Mechanical and chemical debridement typically referred to as debridement, antibiotics, and implant retention (DAIR) can be a successful technique to eradicate PJI in acute postoperative or acute hematogenous infections. This review will focus specifically on the indications, techniques, and outcomes of DAIR.
Discussion:
The success of mechanical and chemical debridement, or a DAIR operation, is reliant on a combination of appropriate patient selection and meticulous technique. There are many technical considerations to take into consideration. One of the most important factors in the success of the DAIR procedure is the adequacy of mechanical debridement. Techniques are surgeon-specific and perhaps contribute to the large variability in the literature on the success of DAIR. Factors that have been shown to be associated with success include the exchange of modular components, performing the procedure within seven days or less of symptom onset, and possibly adjunctive rifampin or fluoroquinolone therapy, though this remains controversial. Factors that have been associated with failure include rheumatoid arthritis, age greater than 80 years, male sex, chronic renal failure, liver cirrhosis, and chronic obstructive pulmonary disease.
Conclusions:
DAIR is an effective treatment option for the management of an acute postoperative or hematogenous PJI in the appropriately selected patient with well-fixed implants.
Insights
Debridement, antibiotics, and implant retention (DAIR) is an effective treatment for acute periprosthetic joint infection (PJI) when performed early and with meticulous technique. Patient selection and surgical approach significantly impact DAIR procedure success rates.
Area of Science:
- Orthopedic surgery
- Infectious diseases
- Arthroplasty revision
Background:
- Periprosthetic joint infection (PJI) is a common complication after hip and knee arthroplasty.
- Early revision for total hip and knee arthroplasty is often necessitated by PJI.
- Debridement, antibiotics, and implant retention (DAIR) is a viable strategy for acute PJI.
Purpose of the Study:
- To review the indications, techniques, and outcomes of DAIR for PJI.
- To highlight critical factors influencing the success of DAIR procedures.
- To provide insights into patient selection and surgical considerations for DAIR.
Main Methods:
- Review of literature on DAIR for periprostastic joint infections.
- Analysis of factors associated with DAIR success and failure.
- Focus on mechanical and chemical debridement techniques.
Main Results:
- DAIR success depends on patient selection and meticulous surgical technique.
- Adequate mechanical debridement is crucial for successful outcomes.
- Factors influencing success include early intervention (≤7 days), modular component exchange, and potentially specific antibiotics.
Conclusions:
- DAIR is an effective treatment for acute PJI in selected patients with stable implants.
- Careful patient selection and precise surgical technique are paramount for DAIR efficacy.
- Understanding factors predicting success or failure aids in optimizing treatment strategies.
