Abstract
Aim
Treatment success of debridement, antibiotics and implant retention (DAIR) is in early periprosthetic joint infection (PJI) is largely dependent on the presence or absence of a mature biofilm. In what time interval a mature biofilm develops is still unclear, and therefore, the time point at which DAIR should be disrecommended remains to be established. This large multicenter trial evaluated the failure rates of DAIR for different time intervals from index arthroplasty to DAIR in early PJI.
Method
We retrospectively evaluated patients with early PJI treated with DAIR between 1996 and 2016. Early PJI was defined as a PJI that developed within 90 days after index arthroplasty. Patients with hematogenous infections, arthroscopic debridements and a follow-up less than one year were excluded. Treatment failure was defined as 1) any further surgical procedure related to infection 2) PJI-related death, or 3) long-term suppressive antibiotics, all within one year after DAIR.
Results
A total of 769 patients were analyzed. Treatment failure occurred in 294 patients (38.2%), and was highest in the early (0–2 weeks) and late (6–12 weeks) post-surgical course: 0–2 weeks: 42.0% (95/226); 2–4 weeks: 37.8% (143/378); 4–6 weeks: 29.0% (29/100), and 6–12 weeks: 41.5% (27/65). Exchange of modular components was performed to a lesser extent in the early compared to the late post-surgical course (40.7% vs 63.2%, p<0.001). The percentage of positive cultures obtained during DAIR decreased according to the time interval from index arthroplasty to DAIR: 0–2 weeks: 88.6%; 2–4 weeks: 86.5%; 4–6 weeks: 75.1%; and 6–12 weeks: 63.2%, p<0.001. The causative microorganisms and the duration of symptoms were comparable between groups (6.7 days, SD ± 5.9, p=0.135).
Conclusions
Although failure rates increase when a DAIR is performed more than six weeks after index arthroplasty, DAIR is still a viable treatment option in these patients in case DAIR is performed as soon as symptoms of infections arise and modular components can be exchanged.
