Outcomes of debridement and implant retention in treating periprosthetic joint infection after primary total joint arthroplasty

Objective To present clinical effects of debridement, antibiotics, irrigation and retention of implant (DAIR) with integrated antibiotics application in treating periprosthetic joint infection (PJI) occurred within 3 months after primary surgery. Methods We retrospectively analyzed patients who received DAIR between January 2011 and October 2015. A total of 49 patients with a mean age of 62.38±14.56 years (range, 26-82 years) were included in this study, including 29 males and 20 females. There are 27 knees and 22 hips. Twenty-three patients has sinus tract. Failure was defined as subsequent surgical intervention for infection after the index procedure; persistent fistula, drainage, or excessive joint pain at the last follow-up; death related to the PJI; chronic suppression with antibiotics. Results There were 18 (36.7%) culture negative cases and 31 (63.3%) culture positive cases, including 28.6% (14/49) methicillin-sensitive staphylococcus aureus, 4% (2/49) methicillin-resistant staphylococcus aureus, 2% (1/49) methicillin-resistant staphylococcus epidermidis, 2%(1/49) mixed infection with fungus and so on. Within the 68.34±14.02 months (range, 39-94 months) follow-up duration, the Knee Society Score (KSS) score was improved from 38.37±12.39 points (range, 18-62 points) pre-operatively to 82.26±10.50 points (range, 49-96 points) post-operatively (t=-17.09, P<0.001). KSS function score was improved from 42.19±10.14 points (range, 26-67 points) pre-operatively to 75.22±11.60 points (range, 41-90 points) post-operatively (t=-12.53, P<0.001). Harris hip score was improved from 47.41±8.39 points (range, 32-58 points) pre-operatively to 86.41±6.07 points (range, 71-96 points) post-operatively (t=-23.38, P<0.001). There were 6 patients receiving subsequent surgical intervention as failure. The mean duration from the index surgery to failure was 5.75±3.00 months (range, 1.5-10 months). Conclusion The present protocol of DAIR for dealing with early-stage PJI, which is less than 3 months after primary TKA or THA, is fairly effective. Key words: Prosthesis-related infections; Debridement; Anti-infective agents, local