Efficacy of Debridement, Antibiotics, and Implant Retention for Periprosthetic Joint Infections Following Hip and Knee Arthroplasty: A Retrospective Cohort Study.

BACKGROUND

This study aimed to determine how well debridement, antibiotics, and implant retention (DAIR) work for treating infections after total hip and knee replacements. Specifically, it compared the success of this treatment in resolving infection, improving function, and preventing complications when the infection occurred early (within three months) versus late (three months to 12 months) after the joint replacement surgery.

OBJECTIVE

The objective of the study is to evaluate DAIR's efficacy in resolving periprosthetic joint infections (PJIs) post-THAs (total hip arthroplasties) and TKAs (total knee arthroplasties), focusing on infection resolution, functional recovery, and complications.

METHODS

This retrospective cohort study reviewed 37 patients (25 TKA, 12 THA) treated with DAIR for PJIs at the UK tertiary centre (2019-2023). PJIs were diagnosed using the 2018 International Consensus Meeting (ICM) criteria.Outcomes (infection status, range of motion (ROM), pain, complications) were assessed via electronic health records, with a mean follow-up of 12.8 months for TKA and 10.4 months for THA. The statistical analysis tool used was IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).

RESULTS

DAIR successfully treated infection in 73.9% of infected total knee replacements and 58.3% of infected total hip replacements (p=0.576). Early infections (within three months) responded better to DAIR (88% for TKA, 91.7% for THA) compared to late infections (0% success, p<0.01). Complications arose in nine TKA and eight THA patients (p=0.157), including three deaths, which were more frequent in late infections (p=0.04). Following DAIR, there were significant reductions in average C-reactive protein levels for both TKA (from 134.5 to 16.9 mg/L, p<0.01) and THA (from 147.1 to 41.6 mg/L, p = 0.03).

CONCLUSION

DAIR achieved infection resolution in 73.9% of TKA and 58.3% of THA cases, particularly when performed within three months of infection onset, while late infections (>three months) had 0% success, emphasising the need for timely intervention and patient selection.