Department of Orthopaedic Surgery and Traumatology, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.
Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
J Orthop Surg Res. 2019 Aug 28;14(1):278. doi: 10.1186/s13018-019-1324-5.
Debridement and irrigation with prosthetic retention followed by antibiotic therapy (DAIR) is one of the treatments of choice in acute infections after a total knee arthroplasty. However, the success rate varies widely in the literature, depending on several factors such as comorbidities of the patient, duration of infection, and microorganisms involved. The goal of this study was to assess the outcomes of this therapeutic option and to identify possible predictors of the result.
We retrospectively reviewed cases of acute postoperative (≤ 3 months from index procedure) and acute hematogenous periprosthetic knee infections treated with DAIR at our hospital between 2004 and 2016. Overall, 26 knees were included, with a mean age of 73.4 years. Several variables related to patient characteristics, infection type, and surgery were examined to evaluate their influence on outcome, and functional and radiographic outcome were assessed. The mean follow-up was 41 months. A descriptive analysis was carried out on the collected data, and a univariate analysis was performed with the objective of searching for influential factors in the resolution of the infection using the chi-square nonparametric test in the case of the categorical variables and the Wilcoxon test for the continuous ones. Moreover, univariate cox regression analysis was performed.
The overall success rate was 77% at the last follow-up, recording a significantly greater cure in acute infections (93% acute vs 58% acute hematogenous, p = 0.03). The infections in which the Staphylococcus aureus was isolated had a significantly lower cure rate, with only 33% of success, compared to 82% of the non-aureus microorganisms (p < 0.05).
The present study shows a considerable cure rate in the treatment of acute knee infections through DAIR, although patient comorbidities, type of infection, and causative microorganism should be considered for decision-making.
清创、灌洗后保留假体并使用抗生素治疗（DAIR）是全膝关节置换术后急性感染的首选治疗方法之一。然而，文献中的成功率差异很大，这取决于患者的合并症、感染持续时间和涉及的微生物等多种因素。本研究旨在评估该治疗选择的结果，并确定可能的结果预测因素。
我们回顾性分析了 2004 年至 2016 年期间在我院接受 DAIR 治疗的急性术后（距指数手术<3 个月）和急性血源性假体周围膝关节感染的病例。共有 26 例膝关节纳入研究，平均年龄为 73.4 岁。检查了与患者特征、感染类型和手术相关的多个变量，以评估它们对结果的影响，并评估功能和影像学结果。平均随访时间为 41 个月。对收集的数据进行描述性分析，并进行单变量分析，目的是使用卡方非参数检验（针对分类变量）和 Wilcoxon 检验（针对连续变量）在感染消退方面寻找影响因素。此外，还进行了单变量 Cox 回归分析。
末次随访时总体成功率为 77%，急性感染的治愈率明显更高（93%急性 vs 58%急性血源性，p=0.03）。金黄色葡萄球菌分离的感染治愈率明显较低，仅为 33%，而非金黄色葡萄球菌微生物的治愈率为 82%（p<0.05）。
本研究表明，通过 DAIR 治疗急性膝关节感染可获得相当高的治愈率，但在决策时应考虑患者的合并症、感染类型和致病微生物。
