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The Mursa Protocol: A Novel Multimodal Antiseptic-Based DAIR Strategy for Early Hip Periprosthetic Joint Infection
Slavko Čičak1,2, Josip Kocur1,2, Dino Gregorović1,2
1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
Antibiotics (Basel, Switzerland)
|June 26, 2026
Summary
A new protocol for treating early hip periprosthetic joint infection (PJI) involving debridement, antibiotics, and implant retention (DAIR) showed high success. This enhanced DAIR strategy improved infection control in complex patients with retained implants.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic joint infection (PJI) after hip arthroplasty presents treatment challenges, with variable success rates for standard Debridement, Antibiotics, and Implant Retention (DAIR).
- Complex cases involving comorbidities, fracture-related arthroplasty, or resistant microorganisms require optimized infection control strategies.
- Local antimicrobial interventions alongside DAIR need further standardization and evaluation.
Purpose of the Study:
- To evaluate the outcomes of a standardized multimodal DAIR protocol (Mursa protocol) for early hip PJI.
- To assess the feasibility, safety, and efficacy of antiseptic microdebridement and local antimicrobial irrigation in high-risk PJI patients.
Main Methods:
- Retrospective case series of 16 patients with early hip PJI treated between 2022-2025.
- Standardized DAIR protocol included radical debridement, mobile component exchange, sequential intraoperative antiseptic microdebridement (povidone-iodine, hypochlorous/hypochlorite), and postoperative local antimicrobial irrigation.
- Treatment success defined by sustained infection eradication, implant retention, and absence of infection-related complications at one-year follow-up.
Main Results:
- The cohort exhibited high complexity: 11/16 fracture-related indications, median Charlson Comorbidity Index of 5, and frequent resistant/polymicrobial infections.
- Treatment success was achieved in 15 of 16 patients (93.8%), with one requiring implant removal.
- No irrigation-related complications, wound healing issues, or systemic toxicity were observed.
Conclusions:
- A structured multimodal DAIR protocol with antiseptic microdebridement and local irrigation is feasible, safe, and effective in high-risk hip PJI patients.
- The protocol demonstrated encouraging infection control, supporting its potential for complex cases.
- Further prospective comparative studies are necessary to validate these hypothesis-generating findings.
