Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection—An 18-Year Experience

• Published in: The Journal of arthroplasty 2017-07, Vol.32 (7), p.2248-2255
• Main Authors: Grammatopoulos, George, DPhil, FRCS (T&O), Kendrick, Benjamin, DPhil, FRCS (T&O), McNally, Martin, FRCS (T&O), Athanasou, Nicholas A., FRCPath, Atkins, Bridget, FRCP, FRCPath, McLardy-Smith, Peter, FRCS, Taylor, Adrian, MSc, FRCS (T&O), Gundle, Roger, DPhil, FRCS
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Arthritis, Infectious - surgery; Arthroplasty, Replacement, Hip - adverse effects; DAIR; Debridement - statistics & numerical data; Female; hip; Hip Joint - surgery; Hip Prosthesis - adverse effects; Humans; Joint Dislocations; Male; Middle Aged; Orthopedics; outcome; periprosthetic joint infection; Prosthesis Retention; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - surgery; Retrospective Studies; revision; Tertiary Care Centers - statistics & numerical data; Treatment Outcome
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.02.066

Abstract Background Debridement-antibiotics-and-implant-retention (DAIR) may be considered a suitable surgical option in periprosthetic joint infections (PJIs) with soundly fixed prostheses, despite chronicity. This study aims to define the long-term outcome following DAIR in hip PJI. Methods We reviewed all hip DAIRs performed between 1997 and 2013 (n = 122) to define long-term outcome and identify factors influencing it. Data recorded included patient demographics, medical history, type of DAIR performed (+/− exchange of modular components), and organisms identified. Outcome measures included complications and/or mortality rate, implant survivorship, and functional outcome (Oxford Hip Score). Results Most DAIRs (67%) were of primary arthroplasties and 60% were performed within 6 weeks from the index arthroplasty. Infection eradication was achieved in 68% of the first DAIR procedure. In 32 cases, more than one DAIR was required. Infection eradication was achieved in 85% of the cases (104/122) with the (single or multiple) DAIR approach. The most common complication was PJI-persistence (15%), followed by dislocation (14%). Very good functional outcomes were obtained, especially in primary arthroplasties. All streptococcus infections were resolved with DAIR and had better outcome. Twenty-one hips have been revised (17%) to-date, 16 were for persistence of PJI. The 10-y implant survivorship was 77%. Early PJI and exchanging modular components at DAIR were independent factors for a 4-fold increased infection eradication and improved long-term implant survival. Conclusion DAIR is, therefore, a valuable option in the treatment of hip PJI, especially in the early postoperative period (≤6 weeks), with good outcomes. However, DAIR is associated with increased morbidity; further surgery may be necessary and instability may occur. Where possible, exchange of modular implants should be undertaken.