Abstract
Aim
To retrospectively evaluate infection eradication rate of DAIR procedures performed in our tertiary referral center. We analyzed whether the outcome was influenced by time of infection after arthroplasty, previous surgery or causative pathogen.
Methods
We retrospectively collected data of 81 patients treated with DAIR for periprosthetic joint infections after hip (n=48) and knee (n=33) arthroplasty between 2011 and 2017. Patients were divided into 3 groups: acute early infections (occurring <4 weeks, 29 cases), late chronic infections (occurring >4 weeks postoperative, 49 cases) and acute haematogenous infections (occuring >3 months after surgery with symptoms less than 4 weeks, 3 cases). Primary outcome was successful infection eradication after treatment within one year. Eradication failure was determined as unplanned subsequent surgery because of persistent infection, use of suppressive antibiotics or signs of infection at one year follow-up.
Results
Patients treated with DAIR (n=25) after previous infection treatment such as DAIR, one- or a two-stage revision showed a success of 44% versus 71% in patients treated with DAIR after primary arthroplasty (n=56). A majority of the patients had a monomicrobial PJI (72%) versus polymicrobial (22%), while 6% were culture negative. Acute early infections, late chronic infections and hematogenous infections had a success rate of 66%, 61% and 67% respectively. The most common pathogen in monomicrobial infections was Staphylococcus aureus (19%) followed by Staphylococcus epidermis (12%). Patients with Staphylococcus aureus infections had a success rate of 60% compared to 80% for Staphylococcus epidermis infections.
Conclusion
Our study shows that good results can be expected when DAIR is performed in patients with acute and late chronic PJI even in a more difficult-to-treat patient population. Interestingly, in 4 out of 10 patients who received a secondary DAIR procedure, the implant could still be retained. Lastly, specific causative organisms can lead to a lower success rate of DAIR.
