Debridement, Antibiotics and Implant Retention (DAIR) Has High Success Rate for Acute Periprosthetic Joint Infection

Background: The efficacy of debridement, antibiotics and implant retention (DAIR) for acute periprosthetic joint infection (PJI) has been debated. The purpose of this study was to report our clinical outcome and experience of managing acute PJI with DAIR. Methods: A retrospective review of all patients diagnosed with acute PJI after hip or knee replacement surgery and managed with DAIR in our prospective joint replacement register from 2008 to 2019 was performed. Patients’ symptom onset duration, inflammatory marker levels, bacteriology, and surgical outcome were tracked and recorded. Results: A total of 24 patients with 7 after hip replacement and 17 after knee replacement were included. Twenty-one were early post-operative infection and 3 were late acute haematogenous infection. During a mean follow-up time of 29.2±15.1 months, twenty-two were successfully treated while 2 failed who required repeated DAIR. The overall success rate of DAIR was 91.7%. For staphylococcal infection, DAIR has 100% success rate. Five patients presented with symptoms between 4 to 8 weeks also achieved 100% success rate. Conclusions: DAIR has a high success rate for acute PJI, and can be performed in selected patients whose symptoms have sustained for over 4 weeks. DAIR has high rate of success for staphylococcal infection. Metagenomic next-generation sequencing (mNGS) test can be used as a potential tool to identify pathogens in acute PJI. Key Words: Debridement, antibiotics and implant retention (DAIR); acute periprosthetic joint infection, debridement, total knee replacement, total hip replacement