J Bone Jt Infect 2019; 4(6):300-305. doi:10.7150/jbji.39168

Research Paper

Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact

Luís Henrique Barros1✉, Tiago Amorim Barbosa1, João Esteves1, Miguel Abreu2,3,4, Daniel Soares1,2,4, Ricardo Sousa1,2,4

1. Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.
2. Department of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal.
3. Grupo TrofaSaude - Hospital em Alfena, Valongo, Portugal.
4. GRIP (Porto Bone and Joint Infection Unit), Centro Hospitalar Universitário do Porto, Portugal.

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Citation:
Barros LH, Barbosa TA, Esteves J, Abreu M, Soares D, Sousa R. Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact. J Bone Jt Infect 2019; 4(6):300-305. doi:10.7150/jbji.39168. Available from http://www.jbji.net/v04p0300.htm

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Abstract

Introduction: Debridement, antibiotics and implant retention (DAIR) is known to be effective in treating acute periprosthetic joint infection (PJI). However, deciding to perform additional surgery in the early postoperative period may be challenging as there is the concern of adding morbidity and clinical presentation is often subtle. We mean to assess the impact of early DAIR on final functional outcome.

Methods: A case-control comparison was performed between patients that underwent DAIR for suspected PJI between 2010-2016 and controls randomly selected (1:2 ratio) from a list of primary joint replacements. Patients were matched for anatomic site, age, gender, American Society of Anesthesiologists (ASA) classification, body mass index and follow-up time. The outcome of surgical treatment and complications were assessed and Hip disability and Osteoarthritis Outcome Score (HOOS) or Knee injury and Osteoarthritis Outcome Score (KOOS) were performed.

Results: Thirty-eight cases were included at a mean follow-up of 42 months. Infection was not confirmed in one patient. There was one infection related-death and three other cases of treatment failure that required a two-stage revision. Overall success rate was 89.2%. There were no significant patient reported differences regarding final functional outcome between both groups: pain 91±6 vs. 87±13; other symptoms 90±8 vs. 90±9; activities of day living 86±8 vs. 85±14; sport 63±13 vs. 57±16; quality of life 78±17 vs. 76±16.

Discussion: These findings support that DAIR for suspected acute PJI is safe, effective and causes no impact on final functional results. Thus, a low threshold for assuming infection and subsequent DAIR may safely be adopted in the early postoperative period.

Keywords: acute prosthetic join infection, antibiotics, debridement, irrigation, retention, functional outcome