Dislocation Rate in Patients Undergoing Debridement, Antibiotics, and Irrigation With Implant Retention for Acute Periprosthetic Hip Infection.

Abstract

Debridement, antibiotics, and irrigation with implant retention (DAIR) is a common treatment for acute or hematogenous periprosthetic joint infection (PJI) of the hip, offering lower short-term morbidity and mortality compared to two-stage revision. While there is an increased risk of postoperative dislocation in revision total hip arthroplasty (THA), limited data exist on the dislocation rate after DAIR. A few available studies investigated the rate of dislocation after DAIR for PJI in THA report rates up to 19.9%. The aim of this study was to identify the dislocation rate after DAIR for PJI in THA and risk factors for dislocation, such as component modifications and surgical approach. A retrospective chart review identified patients treated with DAIR after infection of a primary or revision THA over a 20-year period with a minimum 1-year follow-up. Among DAIR patients, post-DAIR dislocations were recorded, along with demographic data, comorbidities, surgical approach, history of dislocation, number of post-DAIR dislocations, and any necessary follow-up surgical procedures related to the dislocation. Data were analyzed using a regression model to evaluate the dislocation rate after DAIR and significant risk factors were associated with dislocation. Among 176 DAIR patients, 13 (7.4%) experienced dislocations. The 95% Wald-type confidence interval for dislocation rate was 3.5 to 11.3%. Patients with prior dislocations had 3.02 times higher odds of post-DAIR dislocation (odds ratio = 3.02, 95% confidence interval: 0.96 to 9.56; P = 0.06). Surgical approach or details of modular component exchange did not influence outcomes. This study suggests an elevated risk of dislocation after DAIR used for the treatment of PJI in THA, but at a lower rate than previously reported in the literature. The results of this study are comparable to the historically reported results of dislocation rates after head and liner exchange for osteolysis.