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A standardized surgical technique for DAIR improves treatment success rates in acute periprosthetic knee infection
Guillermo Sánchez-Rosenberg1,2, Anna Bartsch1,2, Mario Morgenstern1,2
1Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland.
Purpose:
Results after debridement, antibiotics and implant retention (DAIR) for acute periprosthetic knee joint infections (PJIs) vary widely. Although data are limited, surgeon expertise and surgical technique likely influence outcomes. Standardized DAIR performed by surgeons within a multidisciplinary team (MDT) dedicated to the treatment of PJI was hypothesized to improve treatment success.
Methods:
Patients undergoing DAIR for acute knee PJI at our institution were retrospectively identified, and the outcomes between the two temporally distinct cohorts were compared. Patients treated between January 2005 and May 2015 without a standardized surgical DAIR technique or MDT support comprised the non-standardized cohort. The standardized cohort comprised of patients treated between October 2019 and October 2022 with a standardized DAIR technique and the involvement of an MDT. Treatment success was defined according to the Delphi consensus criteria.
Results:
After screening for eligibility and applying exclusion criteria, 26 cases from the standardized cohort were compared with 31 from the non-standardized cohort. A higher successful treatment rate treatment success rate of 96.3% was observed in the standardized cohort, when compared to the 80.6% success rate of the non-standardized cohort (p = 0.12). Patients in the standardized cohort were older (standardized 75.5 ± 11.2; non-standardized 69.2 ± 9; p = 0.02) and had a longer median interval from time of implantation to DAIR (median interquartile range [IQR] standardized 2.5-13.5 years, non-standardized 0.4-2.8 years; p = 0.98). With respect to the preoperative laboratory values, no significant differences were observed, except for the percentage of polymorph nuclear cells in synovial fluid (standardized 86.3%, non-standardized 90.6%; p = 0.02). Staphylococcus aureus was the most frequently isolated pathogen in both cohorts (standardized [32%], non-standardized cohort [24.13%]; p = 0.55).
Conclusion:
Performing DAIR using a standardized surgical technique with a dedicated MDT resulted in higher treatment success rates when compared to a non-standardized approach.
Level Of Evidence:
Level III, retrospective comparative study.
Insights
Standardized debridement, antibiotics, and implant retention (DAIR) for knee joint infections significantly improved treatment success rates. This approach, involving a multidisciplinary team (MDT), offers better outcomes for patients with periprosthetic joint infections (PJIs).
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Outcomes for debridement, antibiotics, and implant retention (DAIR) in acute periprosthetic knee joint infections (PJIs) show significant variability.
- Surgeon expertise and surgical technique are suspected factors influencing DAIR success rates.
Purpose of the Study:
- To evaluate if a standardized DAIR technique, performed by surgeons within a dedicated multidisciplinary team (MDT), improves treatment success for acute knee PJIs.
- To compare outcomes between a standardized DAIR approach and a non-standardized approach.
Main Methods:
- A retrospective comparative study design was employed.
- Two cohorts were identified: a non-standardized cohort (2005-2015) and a standardized cohort (2019-2022) utilizing a specific DAIR technique and MDT support.
- Treatment success was defined using Delphi consensus criteria.
Main Results:
- The standardized cohort demonstrated a higher treatment success rate (96.3%) compared to the non-standardized cohort (80.6%).
- Patients in the standardized cohort were older (75.5 vs. 69.2 years) and had a longer interval from implantation to DAIR.
- No significant differences were noted in preoperative laboratory values, except for the percentage of polymorph nuclear cells in synovial fluid.
Conclusions:
- Implementing a standardized DAIR surgical technique within a dedicated MDT leads to superior treatment success rates for acute knee PJIs.
- This standardized approach represents a significant advancement in managing periprosthetic knee joint infections.
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