Outcome of Debridement, Antibiotics, and Implant Retention for Treatment of Late Acute Hematogenous Periprosthetic Joint Infections.

Abstract

Late acute hematogenous periprosthetic joint infections (LAHPJIs) pose a unique challenge to the arthroplasty surgeon. While debridement, antibiotics, and implant retention (DAIR) is a common method for treatment, success rates vary widely. Our study aimed to provide clarity on the efficacy of DAIR in treating LAHPJIs, as well as to identify factors associated with treatment success, which may guide decision-making for optimizing patient outcomes. A retrospective review of all LAHPJI cases treated with DAIR from 2010 to 2020 at a single institution was performed. A LAHPJI was defined as symptoms < four weeks in a joint that is > three months from surgery. A PJI was defined by the Musculoskeletal Infection Society criteria. Patients were classified based on McPherson classification, which includes host type (A, B, or C) and extremity grade (1, 2, or 3). Failure was defined as recurrent infection. In total, 152 LAHPJIs (110 knees, 42 hips) were included with a median follow-up of 6.4 years. Kaplan-Meier analysis demonstrated 75% infection-free survival at five years, with 70.7% of failures occurring within the first year after DAIR. McPherson systemic host grade significantly predicted the success of DAIR, with failure rates of 8.7, 24.4, and 40% in type A, B, and C hosts, respectively (P = 0.02). Multivariable regression revealed that type C hosts were 5.3 times more likely to fail treatment than type A (95% confidence interval 1.06 to 26.75, P = 0.04). Polymicrobial infections were most common (30.3%), followed by methicillin-sensitive Staphylococcus aureus (16.4%). A DAIR is a viable treatment option for LAHPJI, especially in type A hosts. Careful history should confirm symptoms for less than four weeks. Patients who have a high comorbidity burden and elevated preoperative inflammatory labs should be monitored closely for treatment failure.