Abstract
Aim
Debridement, antibiotics and implant retention (DAIR) is a widely used treatment modality for early acute prosthetic joint infection (PJI). A preoperative risk score was previously designed for predicting DAIR failure, consisting of chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C) and C-reactive protein >115mg/L (KLIC). The aim of this study was to validate the KLIC score in an external cohort.
Method
We retrospectively evaluated patients with early acute PJI treated with DAIR between 2006 and 2016 in three Dutch hospitals. Early acute PJI was defined as less than 21 days of symptoms and DAIR performed within 90 days after index surgery. Failure was defined as the need for 1) second DAIR, 2) implant removal, 3) suppressive antimicrobial treatment or 4) infection-related death within 60 days after debridement.
Results
A total of 386 patients were included. Failure occurred in 148 patients (38.3%). Patients with KLIC scores of ≤2, 2.5–3.5, 4–5, 5.5–6.5 and ≥7 had failure rates of 27.9%, 37.1%, 49.3%, 54.5% and 85.7% respectively (p<0.001, OR 1.33), in which one point increase in the KLIC score represents a 1.33 times higher risk of failure. The ROC curve showed an area under the curve of 0.64 (95% CI 0.59–0.69). A KLIC score higher than 6 points showed a specificity of 97.9%.
Conclusions
The KLIC score is a relatively good preoperative risk score for DAIR failure in patients with early acute PJI and appears to be most useful in clinical practice for patients with low or high KLIC scores.
