SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION

Simon W. Young; Katy Kim; Mark Zhu; Jacob T. Munro

doi:10.1302/1358-992X.2020.9.004

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SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION

The Knee Society (TKS) 2020 Members Meeting, held online, 10–12 September 2020.

Simon W. Young
Katy Kim
Mark Zhu
Jacob T. Munro

SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION

Young SW, Kim K, Zhu M, Munro JT. SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION. Orthop Procs. 2020;102-B(SUPP_9):4-4. doi:10.1302/1358-992X.2020.9.004

Young, Simon W., et al. “SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION.” Orthopaedic Proceedings, vol. 102-B, no. SUPP_9, 2020, pp. 4-4., https://doi.org/10.1302/1358-992X.2020.9.004

Young, S. W., Kim, K., Zhu, M., & Munro, J. T. (2020). SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION. Orthopaedic Proceedings, 102-B(SUPP_9), 4-4. https://doi.org/10.1302/1358-992X.2020.9.004

Young, S. W., Kim, K., Zhu, M. and Munro, J. T. (2020) “SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION.” Orthopaedic Proceedings, 102-B(SUPP_9), pp. 4-4. Available at: https://doi.org/10.1302/1358-992X.2020.9.004

Young, Simon W., Katy Kim, Mark Zhu, and Jacob T. Munro. “SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION.” Orthopaedic Proceedings 102-B, no. SUPP_9 (2020): 4-4. https://doi.org/10.1302/1358-992X.2020.9.004

Young SW, Kim K, Zhu M, Munro JT. SUCCESS RATES OF DEBRIDEMENT, ANTIBIOTICS AND IMPLANT RETENTION (DAIR) IN 230 INFECTED TOTAL KNEE ARTHROPLASTIES: IMPLICATIONS FOR CLASSIFICATION OF PERIPROSTHETIC JOINT INFECTION. Orthop Procs. 2020 Oct 1;102-B(SUPP_9):4-4. https://doi.org/10.1302/1358-992X.2020.9.004

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Abstract

Introduction

Treatment of prosthetic joint infection (PJI) following total knee arthroplasty (TKA) may guided by PJI classification, taking into account infection duration and potential for biofilm formation. Debridement, antibiotics and implant retention (DAIR) is recommended for ‘post-operative’ and ‘acute’ haematogenous PJI. However, the time cut-off for ‘post-operative’ PJI varies across classification systems. Furthermore, poor DAIR success rates have been reported in acute haematogenous PJIs. This study aimed to determine the success of DAIR in a large cohort of PJIs, and assess the utility of current classification systems for predicting DAIR outcomes.

Method

In this multicentre retrospective, cohort study, we identified 230 patients undergoing DAIR for first episode PJI following primary TKA. Patient demographics, disease and surgical factors were identified, and PJI subtype, post-operative antibiotic regime and treatment outcomes were recorded. Statistical analysis was performed to identify factors associated with failed DAIR, and success rates were analysed by multiple classification systems using receiver operating characteristic (ROC) curves.

Results

At average follow-up of 6.9 years, DAIR failed in 46% of cases. ROC analysis found 3 month and 1 year cut-offs for ‘post-operative’ PJIs were equally predictive of outcomes (AUC=0.63). On multivariate survival analysis, DAIR failed in 63% of late haematogenous PJIs (implant age>1 year) compared to 36% of early (<1year) PJIs (OR=1.78, p=0.01). Staphylococcus aureus (OR=4.70, p<0.001) and gram negative infections (OR=2.56, p=0.031) were risk factors for DAIR failure in late PJIs.

Conclusions

We found a high failure rate in late infections following TKA, irrespective of their classification as ‘acute haematogenous’ or ‘chronic’. Higher DAIR success rates were seen with implant age <1year. These findings call into question the utility of current classification systems based on duration of bacterial presence. For late infections (>1year), PJI caused by S. aureus or gram negative bacteria have a higher failure rate when treated with DAIR.