[Debridement, antimicrobial therapy, and implant retention for acute periprosthetic infections]

The DAIR procedure (debridement, antibiotic therapy, and implant retention) represents a treatment option for acute periprosthetic joint infections (PJI). Compared to revision arthroplasty, it is technically less invasive and, under appropriate indications, can preserve a well-fixed endoprosthesis. However, treatment success depends on numerous patient-, pathogen-, and procedure-related factors.

Based on a comprehensive review of current international studies and guidelines, we systematically analyzed the key factors influencing the success of DAIR. In addition, clinical experiences from our orthopedic department, particularly with staphylococcal infections, were evaluated and integrated.

Critical success factors for DAIR include early intervention within 3 weeks of symptom onset, exchange of all mobile components, stable implant fixation, intact soft tissue envelope, and consideration of risk factors such as advanced age, immunosuppressive therapy, COPD, or rheumatoid arthritis. The choice of antibiotic regimen, especially rifampicin-based combination therapy for staphylococcal infections, affects the outcome significantly.

DAIR can be an effective treatment option with favorable healing rates under clearly defined conditions. Careful patient selection, a multidisciplinary case review, and strict adherence to surgical and antimicrobial standards are essential to improve success rates. In unfavorable clinical situations, a direct implant revision should be considered instead.