Double DAIR Protocol for Acute Periprosthetic Joint Infection: A 15-Year Institutional Experience.

Abstract

Recently, the double debridement, antibiotics, and implant retention (DAIR) using antibiotic-loaded bone cement beads for the treatment of acute periprosthetic joint infection (PJI) has gained traction following promising reports in the literature. The purpose of this study was to examine the clinical outcomes of this protocol and identify predictors of failure following completion of a double DAIR procedure. This retrospective study identified all patients who underwent a double DAIR protocol for the management of acute PJI (≤ 28 days from either index arthroplasty or symptom onset) at a single institution. Acute PJI was defined using the 2013 Musculoskeletal Infection Society criteria. All patients had a minimum of 1-year follow-up. Treatment failure was defined as reoperation secondary to infection, PJI-related mortality, or signs of persistent infection at the latest follow-up. There were 128 patients (69 knees and 59 hips) included in the final analyses. At a mean follow-up time of 4.8 ± 3.9 years, 86.1% of infected primaries and 71.4% of infected revision patients were found to have experienced treatment success. When adjusting for covariates, multivariate regression analyses identified revision arthroplasty (odds ratio [OR], 7.6; P = 0.002), acute hematogenous PJI (OR, 7.1; P = 0.048), and positive culture at second debridement (OR, 5.0; P = 0.039) as independent predictors of failure following completion of a double DAIR procedure. We found that 86.1% of infected primaries and 71.4% of infected revisions that received a double DAIR for acute PJI were infection-free at the latest follow-up. On regression analyses, revision arthroplasty, acute hematogenous PJI, and a positive culture at second debridement were found to be independent predictors of treatment failure in this patient population.