Timing of Debridement, Antibiotics, and Implant Retention for Early Periprosthetic Joint Infection

Abstract

<h3>Background: </h3><p>Debridement, antibiotics, and implant retention (DAIR) is the method of choice in the treatment of acute periprosthetic joint infection (PJI). However, the optimal timing of DAIR is somewhat unclear. We assessed the success of DAIR performed during different time intervals after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from the Finnish Arthroplasty Register (FAR).</p><h3>Methods: </h3><p>There were 178,498 primary operations (78,888 THAs and 99,610 TKAs) from May 2014 to April 2022 recorded in the FAR. Male patients represented 53.4% of the THA group and 55.5% of the TKA group. The most common age group was ≤62 years in the THA group and ≥76 years in the TKA group. All patients were of Finnish ethnicity. A total of 1,014 DAIR procedures were performed within 6 months after the primary arthroplasty. Cases of reoperation after DAIR were followed for 1 year after the DAIR; re-revision due to PJI within 1 year was regarded as a failure of the DAIR treatment. We compared the failure rate of DAIR among 3 time intervals: 0 to 42, 43 to 84, and 85 to 180 days after the primary operation. A Cox regression model was used to assess risk factors for re-revision.</p><h3>Results: </h3><p>In the THA group, the failure rate was 15.1% when DAIR was performed within 42 days, 10.0% when performed at 43 to 84 days, and 31.4% when performed at 85 to 180 days after the primary THA. In the TKA group, the failure rate was 8.9% when DAIR was performed within 42 days, 16.7% when performed at 43 to 84 days, and 9.8% when performed at 85 to 180 days after the primary TKA. Later DAIR was not associated with an increased re-revision risk, compared with the reference of 0 to 42 days, in the THA group (43 to 84 days: hazard ratio [HR], 1.2 [95% confidence interval (CI), 0.6 to 2.2; p = 0.63]; 85 to 180 days: HR, 1.4 [95% CI, 0.6 to 3.0; p = 0.41]). The same was true in the TKA group (43 to 84 days: HR, 1.0 [95% CI, 0.4 to 2.4; p = 0.98]; 85 to 180 days: HR, 1.9 [95% CI, 1.0 to 3.8; p = 0.065]).</p><h3>Conclusions: </h3><p>The failure rate of DAIR may not increase as much as previously thought if performed >6 weeks after primary total joint arthroplasty. Thus, DAIR can also be worth considering as a treatment method for PJI beyond the first 6 weeks postoperatively, depending on the severity of the case.</p>