Debridement, Antibiotics and Implant Retention in Early Periprosthetic Joint Infection

2016 ◽  
Vol 26 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Magnus Bergkvist ◽  
Sebastian S. Mukka ◽  
Lars Johansson ◽  
Torbjörn E. Ahl ◽  
Arkan S. Sayed-Noor ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Implant Retention

scholarly journals Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty

2019 ◽  
Vol 71 (3) ◽  
pp. 630-636 ◽  
Author(s):  
Claudia A M Löwik ◽  
Javad Parvizi ◽  
Paul C Jutte ◽  
Wierd P Zijlstra ◽  
Bas A S Knobben ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Viable Option ◽  
Time Intervals ◽  
Implant Retention ◽  
Time Point ◽  
Viable Treatment

Abstract Background The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.

Debridement, Antibiotics and Implant Retention (DAIR) in Periprosthetic Joint Infection (PJI): what predicts success or failure?

2021 ◽  
Author(s):  
Rui Xiang Toh ◽  
Zhen Ning Yeo ◽  
Ming Han Lincoln Liow ◽  
Jerry Yongqiang Chen ◽  
Seng-Jin Yeo ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Implant Retention

scholarly journals Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bruno Alves Rudelli ◽  
Pedro Nogueira Giglio ◽  
Vladimir Cordeiro de Carvalho ◽  
José Ricardo Pécora ◽  
Henrique Melo Campos Gurgel ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Resistance Profile ◽  
Drug Resistance Profile ◽  
Implant Retention

scholarly journals Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection

2020 ◽  
Vol 12 (2) ◽  
pp. 463-470 ◽  
Author(s):  
Chao‐fan Zhang ◽  
Long He ◽  
Xin‐yu Fang ◽  
Zi‐da Huang ◽  
Guo‐chang Bai ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Implant Retention

scholarly journals The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study

2017 ◽  
Vol 64 (12) ◽  
pp. 1742-1752 ◽  
Author(s):  
Jaime Lora-Tamayo ◽  
Éric Senneville ◽  
Alba Ribera ◽  
Louis Bernard ◽  
Michel Dupon ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Good Prognosis ◽  
Large Multicenter Study ◽  
Implant Retention

scholarly journals Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wang Deng ◽  
Rui Li ◽  
Hongyi Shao ◽  
Baozhan Yu ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Sinus Tract ◽  
Success Rates ◽  
Implant Retention ◽  
Potential Risk Factors

Abstract Background The relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract. Methods Consecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored. Results One hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038). Conclusions The presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.

scholarly journals Debridement, Antibiotics and Implant Retention (DAIR) Has High Success Rate for Acute Periprosthetic Joint Infection

2019 ◽  
Author(s):  
Chaofan Zhang ◽  
Long He ◽  
Xinyu Fang ◽  
Zida Huang ◽  
Guochang Bai ◽  
...  
Keyword(s):  
Success Rate ◽  
Knee Replacement ◽  
Periprosthetic Joint Infection ◽  
Hip Replacement ◽  
Inflammatory Marker ◽  
Joint Infection ◽  
Staphylococcal Infection ◽  
High Rate ◽  
High Success Rate ◽  
Implant Retention

Abstract Background: The efficacy of debridement, antibiotics and implant retention (DAIR) for acute periprosthetic joint infection (PJI) has been debated. The purpose of this study was to report our clinical outcome and experience of managing acute PJI with DAIR. Methods: A retrospective review of all patients diagnosed with acute PJI after hip or knee replacement surgery and managed with DAIR in our prospective joint replacement register from 2008 to 2019 was performed. Patients’ symptom onset duration, inflammatory marker levels, bacteriology, and surgical outcome were tracked and recorded. Results: A total of 24 patients with 7 after hip replacement and 17 after knee replacement were included. Twenty-one were early post-operative infection and 3 were late acute haematogenous infection. During a mean follow-up time of 29.2±15.1 months, twenty-two were successfully treated while 2 failed who required repeated DAIR. The overall success rate of DAIR was 91.7%. For staphylococcal infection, DAIR has 100% success rate. Five patients presented with symptoms between 4 to 8 weeks also achieved 100% success rate. Conclusions: DAIR has a high success rate for acute PJI, and can be performed in selected patients whose symptoms have sustained for over 4 weeks. DAIR has high rate of success for staphylococcal infection. Metagenomic next-generation sequencing (mNGS) test can be used as a potential tool to identify pathogens in acute PJI. Key Words: Debridement, antibiotics and implant retention (DAIR); acute periprosthetic joint infection, debridement, total knee replacement, total hip replacement

scholarly journals 255. Utility of Magnetic Resonance Imaging in Predicting Failure of DAIR (Debridement, Antibiotics, and Implant Retention) for Treatment of Periprosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S234-S234
Author(s):  
Milan Kapadia ◽  
Alissa Burge ◽  
Eric Bogner ◽  
Peter Sculco ◽  
Alberto V Carli
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Treatment Failure ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Univariate Analysis ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Adjacent Tissue ◽  
Implant Retention

Abstract Background Debridement, antibiotics, and implant retention (DAIR) is commonly utilized to treat acute periprosthetic joint infection (PJI) where thorough debridement of affected tissues is considered essential. Small case series describe occurrences where PJI spreads into adjacent tissues (iliopsoas recess in hips; neurovascular bundle in knees) and bone (osteomyelitis). Surgeons often cite adjacent tissue/bone infiltration as a poor predictor for DAIR. We sought to evaluate if the presence of adjacent tissue/bony lesions on preoperative magnetic resonance imaging (MRI) was associated with poorer DAIR outcomes. Methods MSIS criteria-positive hip (n=22) and knee (n=12) PJI cases in our institution from 2010-2020, with preoperative MRI prior to DAIR treatment, were evaluated. Demographics, microbiology, chronicity, and host grade were recorded. MRIs were assessed by two board-certified radiologists blinded to treatment outcomes, scoring images based on the presence of 18 distinct findings. Inter-rater reliability was calculated using bias adjusted Kappa scores. Failure was defined as repeat surgery for PJI. Univariate analysis and logistic regression were used to determine predictors of DAIR success at 90 days and 2 years. Results When comparing successful and non-successful hip PJI cases, the presence of a psoas recess fluid collection on MRI was significantly predictive of a higher rate of treatment failure at 2 years (odds ratio=0.12; p = 0.045), with a moderate adjusted kappa score of 0.5. With regard to knee PJI cases, capsular disruption (40% [2/5] vs 100% [7/7], p= 0.046) and patellar tendon disruption (25% [1/4] vs 100% [8/8], p = 0.018) were independently associated with higher 90-day failure. However, knee MRI findings were not predictive of failure using regression. Conclusion In this preliminary study, preoperative MRI findings anecdotally linked with PJI treatment failure could be reliably identified. However, few predicted DAIR failure. Further studies are needed to clarify the role of MRI in predicting PJI treatment success. Disclosures All Authors: No reported disclosures

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