One-year success after debridement, antibiotic therapy, and implant retention for acute hip and knee periprosthetic joint infection: a retrospective cohort study of 62 patients.

Abstract

The aim of this study was to evaluate the success rate in cases of acute prosthetic joint infection (PJI) of the knee or hip treated with debridement, antibiotics, and implant retention (DAIR), and to identify risk factors associated with treatment failure. A retrospective study was conducted involving adult patients treated with DAIR for PJI of the knee or hip, with a minimum follow-up of 12 months. Success was defined as the absence of signs of recurrence or reinfection 12 months post-DAIR. Cases reviewed for infectious reasons or those on chronic suppressive antibiotic therapy were considered failures. The need for an additional DAIR within 10 days of the first was not classified as failure. The final cohort included 62 patients, of whom 35 (56.4%) were male. A total of 45 (72.6%) achieved success with a single DAIR procedure. Failure was significantly more common in patients with polymicrobial infections (58.8% vs. 13.3%; p < 0.01; OR 8.7 [2.3-32.2]) and those with hip PJI (88.2% vs. 48.9%; p = 0.008; OR 7.1 [1.4-33.6]). The presence of persistent wound drainage was associated with a higher risk of failure (52.9% vs. 17.7%; p = 0.002; OR 5.2 [1.6-18.4]). The survival rate at the end of the study was 93.6%. DAIR is an effective option for treating acute PJIs of the knee and hip. The presence of a persistent wound drainage, polymicrobial infections, and hip arthroplasty are independent risk factors for treatment failure.