Abstract
Introduction
Success rate after Debridement-Irrigation, Antibiotic Therapy and Implant Retention (DAIR) for treatment of Acute Haematogenous (AH) and Early Post-surgical (EP) periprosthetic joint infection (PJI) varies widely among published studies. Prosthesis exchange is recommended to treat PJI after a failed DAIR. However, no early postoperative prognostic factors permitting to identify future failures have been described.
Aim
Identify early prognostic factor of failure after DAIR in order to propose efficient treatment before onset of chronic PJI.
Hypothesis
Positive suction drainage fluid culture is a strong early predictive factor of failure.
Methods
We conducted a retrospective study, with a minimum 2 years follow-up. Twenty-two consecutive patients (78 years-old +/-10) with EPPJI: i.e. infection within 1 month after joint replacement (n=12; 55%) or AHPJI: i.e. acute haematogenous infection with less than 2 weeks evolution (n=10; 45%) were included. The involved prostheses were: Total Knee Arthroplasty (n=12; 55%), Total Hip Arthroplasty (n=7; 32%) and Hip Hemi-Arthroplasty (n=3; 14%).
DAIR was indicated for each patient. Suction drainage fluid was systematically analysed at day 1, 3 and 5 postoperative.
Failure of the procedure was defined as: need for iterative surgery to control PJI or suppressive antibiotherapy to control PJI or death related to PJI.
Results
At 2 years follow-up, failure rate after DAIR was 55%. Only positive suction drainage fluid culture was statistically associated with treatment failure (p=0,039).
Neither type of prosthesis: knee prosthesis vs hip prosthesis (Odds Ratio (OR)=1; IC95%[0.14; 7.21]) nor type of fixation : cemented vs uncemented prothesis (OR=4,39; IC95%[0.29; 269]) were associated with treatment failure.
In addition, type of bacteria causing PJI and especially S. aureus (OR=3,1; IC95%[0.42; 28.61]), type of infection (OR= 1,47; IC95%[0.21; 11.37]), delay between onset of symptoms and DAIR (OR= 1,63; IC95% [0.21; 14.85]) or retaining of modular component (OR= 1.32; IC95% [0.17; 10.59)) were not associated with a higher rate of failure.
Conclusion
Positive suction drainage fluid culture could be an early postoperative predictive factor of failure after open Irrigation-Debridement, Antibiotic Therapy and Implant Retention for EPPJI and AHPJI.
