Abstract
INTRODUCTION
Deep infection is a potentially catastrophic complication of joint replacement surgery. Early intervention in suspected prosthetic joint infection in the form of aggressive Debridement and targeted Antibiotics can lead to successful Implant Retention (DAIR). In our centre, we adopt an aggressive approach to suspected prosthetic joint infection, working in a multi-disciplinary team with microbiologists and an infection surveillance team to identify and treat suspected infected cases at the earliest opportunity.
OBJECTIVES
To evaluate the efficacy of the treatment of prosthetic joint infection with DAIR.
METHODS
All cases of primary prosthetic joint infection between March 2009 and September 2011 were identified. Data was retrospectively collected from root cause analysis data, patient records and hospital electronic results systems.
RESULTS
48 cases of confirmed deep infection were identified from a total of 5037 primary joint replacements. Mean age was 67.3. The mean time between index procedure and return to theatre for debridement was 18 days. 10 patients underwent a second debridement and 3 returned to theatre for a third debridement. Mean total duration of antibiotic treatment was 10.5 weeks with mean duration of intravenous antibiotics 2.7 weeks. There were two early and three late failures on antibiotics. These went on to have successful two stage revision. The mean interval to debridement in failed cases was 15 days. The primary implant was successfully retained in 90% of cases (n=43) at a mean follow up of 30 months.
CONCLUSION
DAIR is an effective means of treating early prosthetic joint infection in a multi-disciplinary setting.
