Are KLIC and CRIME-80 scores useful to assist decision-making initially or at the moment of repeat DAIR? - a...

Introduction: Debridement, antibiotics, and implant retention (DAIR) is recommended for early acute postoperative and late acute periprosthetic joint infections (PJIs). The KLIC and CRIME-80 scores have been proposed to predict DAIR outcomes. Nevertheless, their clinical utility remains uncertain. This study aimed to evaluate their predictive value for DAIR failure in our cohort, both at primary indication and when repeat DAIR was considered necessary. Methods: We retrospectively reviewed all patients who underwent DAIR for total hip or knee PJI between 2010 and 2021, with at least 1 year of follow-up. Failure was defined as persistent infection, need for implant removal, amputation, or infection-related death. Results: A total of 102 patients were included, with a mean follow-up of 48.9 months. The overall failure rate was 35.3 %. Failure rates did not differ significantly between patients who underwent a single DAIR and those who required repeat procedures (32.5 % vs. 45.5 %, $p=$  0.26). No significant correlations were found between KLIC or CRIME-80 scores and failure rates, either at the initial indication for DAIR ( $p=$  0.54 and $p=$  0.93, respectively) or in repeat DAIR procedures ( $p=$  0.44 and $p=$  0.50, respectively). Conclusions: In our cohort, the KLIC and CRIME-80 scores were not predictive of DAIR failure, either at initial treatment or when repeat DAIR was required. These scores offered limited prognostic value and did not support clinical decision-making. Prospective studies are needed to validate and improve predictive tools for DAIR outcomes.