A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT

S. Roskar; R. Mihalic; A. Mihelic; R. Trebse

doi:10.1302/1358-992X.2022.10.069

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General Orthopaedics

A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT

The European Bone and Joint Infection Society (EBJIS) Meeting, Graz, Austria, 8–10 September 2022.

S. Roskar
R. Mihalic
A. Mihelic
R. Trebse

A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT

Roskar S, Mihalic R, Mihelic A, Trebse R. A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT. Orthop Procs. 2022;104-B(SUPP_10):69-69. doi:10.1302/1358-992X.2022.10.069

Roskar, S., et al. “A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_10, 2022, pp. 69-69., https://doi.org/10.1302/1358-992X.2022.10.069

Roskar, S., Mihalic, R., Mihelic, A., & Trebse, R. (2022). A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT. Orthopaedic Proceedings, 104-B(SUPP_10), 69-69. https://doi.org/10.1302/1358-992X.2022.10.069

Roskar, S., Mihalic, R., Mihelic, A. and Trebse, R. (2022) “A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT.” Orthopaedic Proceedings, 104-B(SUPP_10), pp. 69-69. Available at: https://doi.org/10.1302/1358-992X.2022.10.069

Roskar, S., R. Mihalic, A. Mihelic, and R. Trebse. “A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT.” Orthopaedic Proceedings 104-B, no. SUPP_10 (2022): 69-69. https://doi.org/10.1302/1358-992X.2022.10.069

Roskar S, Mihalic R, Mihelic A, Trebse R. A SERIES OF 100 CONSECUTIVE DAIR PROCEDURES IN PRIMARY TOTAL KNEE AND HIP ARTHROPLASTY INFECTION: SINGLE-CENTRE OUTCOME REPORT. Orthop Procs. 2022 Oct 1;104-B(SUPP_10):69-69. https://doi.org/10.1302/1358-992X.2022.10.069

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Abstract

Aim

Debridement, antibiotics and implant retention (DAIR) are considered as an optimal curative treatment option for prosthetic joint infection (PJI) when the biofilm is still immature and radical debridement is achievable. There are two main groups of patients suitable for DAIR. Those with an early acute PJI and patients with acute hematogenous PJI. However, there is also a third group of early PJI resulting from a wound healing problem or leaking hematoma. These may be either high or low grade depending on the microorganisms that infected the artificial joint “per continuitatem”.

Methods

We retrospectively analysed 100 successive DAIR procedures on prosthetic hip and knee joints performed between January 2010 and January 2022, from total of 21000 primary arthroplasties implanted within the same time period. We only included PJI in primary total replacements with no previous surgeries on the affected joint. Patients data (demographics, biochemical, microbiological, histopathological results, and outcomes) were collected from hospital bone and joint infection registry. The aim of surgery was radical debridement and the mobile parts exchange. The standardized antibiotic regime based on antibiofilm antibiotics.

Results

The mean age of patients was 70 years (60% women, 43 hips, 57 knees) with a mean follow-up of 3 years. 45 cases were early acute or related to wound healing problems, 55 were hematogenous PJI. 25 patients received preoperative antibiotics. 6 of these were culture negative. The mean symptom duration was 7 days. Mean age of the prosthesis was 30 days for early, and 1064 days for the hematogenous group.

Conclusions

In our cohort the success rate of DAIR is 94% which indicates that the protocol is highly successful in PJI with short-lasting symptoms and “debridable” joints. Antibiotic protocol violation and duration of symptoms may have a role in failures.

E-mail: samo.roskar@ob-valdoltra.si