Aims To analyse the effectiveness of debridement and implant retention (DAIR) in patients with hip periprosthetic joint infection (PJI) and the relationship to patient characteristics. The outcome was evaluated in hips with confirmed PJI and a follow-up of not less than two years.
Patients and Methods Patients in whom DAIR was performed were identified from our hip arthroplasty register (between 2004 and 2013). Adherence to criteria for DAIR was assessed according to a previously published algorithm.
Results DAIR was performed as part of a curative procedure in 46 hips in 42 patients. The mean age was 73.2 years (44.6 to 87.7), including 20 women and 22 men. In 34 hips in 32 patients (73.9%), PJI was confirmed. In 12 hips, the criteria for PJI were not fulfilled and antibiotics stopped. In 41 (89.1%) of all hips and in 32 (94.1%) of the confirmed PJIs, all criteria for DAIR were fulfilled. In patients with exogenous PJI, DAIR was performed not more than three days after referral. In haematogenous infections, the duration of symptoms did not exceed 21 days. In 28 hips, a single debridement and in six hips two surgical debridements were required. In 28 (87.5%) of 32 patients, the total treatment duration was three months. Failure was noted in three hips (9%). Long-term follow-up results (mean 4.0 years, 1.4 to 10) were available in 30 of 34 (88.2%) confirmed PJIs. The overall successful outcome rate was 91% in 34 hips, and 90% in 30 hips with long-term follow-up results.
Conclusion Prompt surgical treatment with DAIR, following strict diagnostic and therapeutic criteria, in patients with suspected periprosthetic joint infection, can lead to high rates of success in eradicating the infection.
Cite this article: Bone Joint J 2017;99-B:330–6.
P. Sendi: Obtained patient data, Developed the study design, Data analysis, Writing the paper.
P. O. Lötscher: Obtained patient data, Writing the paper.
B. Kessler: Clinical responsibility for patients, Writing the paper.
P. Graber: Clinical responsibility for patients, Contributed to the generation of the data and cohort data bank.
W. Zimmerli: Data analysis, Contributed to the generation of the data and cohort data bank, Writing the paper.
M. Clauss: Clinical responsibility for patients, Data analysis, Contributed to the generation of the data and cohort data bank, Writing the paper.
P. Sendi and P. O. Lötscher contributed equally to this work.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by D. Johnstone and first proof edited by G. Scott.
- Received June 29, 2016.
- Accepted October 21, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery