Treatment Failure Rates Significantly Decrease at One and Five Years After Debridement, Antibiotics, and Implant...

Periprosthetic joint infection (PJI) is a leading cause of total knee arthroplasty (TKA) failure. Debridement, antibiotics, and implant retention (DAIR) is the preferred treatment for acute PJI. The objectives of this study were to determine the length of time TKA PJIs should be monitored after DAIR and the time point where the majority of PJI treatment failure occurs.

This study, spanning 2005 to 2022, involved 108 patients from 16 hospitals within a regional health system. Patients had an average follow-up of 9.8 years. Bayesian regression with Monte Carlo Markov Chain simulation was employed to identify significant breakpoints in cumulative failure curves.

Our single and double breakpoint models identified significant decreases in the failure rates at 1.02 and 0.92 years for the entire cohort, respectively. Our double breakpoint model also identified 4.49 years as a point of significant decrease in failure rate.

This study suggests that most failures for acute TKA PJI treated with DAIR occur within one year, with significant breakpoints identified at approximately one and five years. Our results suggest monitoring these patients between a range of one and five years.