Abstract
Introduction
The value of Debridement-Antibiotics-and-Implant-Retention (DAIR) in prosthetic-joint-infection (PJI) is still a matter of debate as most studies to-date are underpowered with variable end-points. In our, tertiary referral, bone infection unit we consider DAIR to be a suitable option in all PJIs with soundly fixed prostheses, despite chronicity. The aims of this study were to define the long-term outcome following DAIR in hip PJI and identify factors that influence it.
Methods
This is a retrospective consecutive case series of DAIRs performed between 1997 and 2013. Only infected cases confirmed by established criteria were included. Data recorded included patient demographics, medical history (ASA grade, Charlson and KLICC scores), type of surgery performed (DAIR or DAIR + exchange of modular components) and organism grown. Outcome measures included complications, implant survivorship and functional outcome (Oxford Hip Score, OHS).
Results
122 DAIRs were identified with mean age of 71 years; most (67%) were following an index 1° arthroplasty procedure and 60% were for early PJI (< six weeks). The overall chance of infection eradication with DAIR was 86%. Very good functional outcomes were obtained, especially in 1° hips (OHS: 39). All infections secondary to streptococcus resolved with DAIR and had better functional outcome. Early PJI and exchange of modular components at DAIR were independently associated with a four-fold increased chance of infection eradication, and improved implant survival. The most common complication was persistence of infection (31%, which was eradicated in most with repeat DAIR) followed by dislocation (14%). Twenty-one hips have been revised to-date (17%); 10-yr implant survivorship was 77%.
Discussion
DAIR is a valuable option in hip PJI treatment, especially in the early post-operative period with good resultant outcome. However, DAIRs can be associated with increased morbidity, further surgery may be necessary and instability may occur. Whenever possible, exchange of modular implants should be undertaken.
DAIR is a particularly valuable option in the treatment of hip PJI.
