Debridement, antibiotics and implant retention: are all approaches to periprosthetic joint infection equal? Same procedures, different outcomes

The reported success rate of debridement, antibiotics, and implant retention (DAIR) for periprosthetic joint infection varies considerably between studies, despite institutions reporting use of the same procedure. In this narrative review, we aim to delineate the differences between the various DAIR approaches and highlight why they influence the outcome.

We performed a PubMed and internet search investigating the different approaches for DAIR and their associated outcomes.

Twenty-two studies with defined infection criteria, consisting of 50 or more periprosthetic joint infection cases and a follow-up of 1 year or longer, were included.

Most studies did not report whether the presence of a sinus tract was a criterion for not performing DAIR, and the use of biofilm-active agents for curative DAIR was only reported in a few studies. The duration of infection as criterion for early postoperative and acute haematogenous infection varied between studies. The epidemiology of host factors and microorganisms, healthcare systems, patient-doctor interactions, and decision-making processes for surgical interventions vary worldwide, and so do the indications for DAIR.

Studies should precisely declare the indication for DAIR, the variables that influence decision-making for treatment options, the surgical technique applied, and the type and duration of antimicrobial therapy. Such an approach will increase the quality of research data and allow the development of recognized subcategories of DAIR.