Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA.
J Arthroplasty. 2020 Sep;35(9):2590-2594. doi: 10.1016/j.arth.2020.04.068. Epub 2020 Apr 27.
Debridement, antibiotics, and implant retention (DAIR) is an appealing treatment option for periprosthetic joint infection (PJI) due to its low cost and low morbidity. There are many nonmodifiable risk factors for DAIR failure that have previously been established. A dual DAIR setup constitutes establishing a new, sterile field after the initial debridement. The purpose of this study is to determine whether the modifiable surgical technique of a dual setup improves the infection control rate following PJI.
A retrospective study was conducted from January 1, 2000 to December 31, 2017 to identify patients who underwent a DAIR procedure as initial surgical treatment for PJI of the hip or knee. Patients were divided between 2 groups, failed and successful DAIR procedures. Failure was defined as infection recurrence requiring surgical intervention. Demographic (age, gender, body mass index, smoking status, American Society of Anesthesiologists status), preoperative comorbidity (hypertension, cardiac disease, diabetes status, depression or anxiety diagnosis, pulmonary disease), operating surgeon, single vs dual setup, hospital, use of long-term antibiotics postoperatively (greater than 6 weeks of intravenous antibiotics), joint, and laterality data were compared between cohorts using multivariate regression analysis.
Two hundred sixty-three patients were identified who underwent DAIR as the exclusive and initial treatment for PJI. Single vs dual setup, knee vs hip joint, cardiac or vascular disease diagnosis, major depressive disorder or generalized anxiety disorder diagnosis, and staphylococcal infections were found to be independent predictive variables for DAIR failure.
In our series, the dual setup DAIR was a modifiable surgical technique that significantly decreased the risk of infection recurrence compared to single setup DAIR.
清创术、抗生素和保留植入物（DAIR）由于其成本低、发病率低，因此成为治疗人工关节周围感染（PJI）的一种有吸引力的治疗选择。以前已经确定了许多不可改变的 DAIR 失败的风险因素。双重 DAIR 方案构成了在初次清创后建立新的无菌区域。本研究的目的是确定可改变的手术技术（双重设置）是否可以提高 PJI 后感染控制率。
回顾性研究于 2000 年 1 月 1 日至 2017 年 12 月 31 日进行，以确定接受 DAIR 手术作为髋或膝关节 PJI 初始手术治疗的患者。患者分为两组，即失败和成功的 DAIR 手术。失败定义为需要手术干预的感染复发。使用多元回归分析比较了两组患者的人口统计学（年龄、性别、体重指数、吸烟状况、美国麻醉师协会状态）、术前合并症（高血压、心脏病、糖尿病状态、抑郁或焦虑诊断、肺部疾病）、手术医生、单重与双重设置、医院、术后长期使用抗生素（静脉抗生素大于 6 周）、关节和侧别数据。
确定了 263 名接受 DAIR 作为 PJI 唯一和初始治疗的患者。单重与双重设置、膝关节与髋关节、心脏或血管疾病诊断、重度抑郁症或广泛性焦虑症诊断以及葡萄球菌感染被认为是 DAIR 失败的独立预测因素。
在我们的系列中，与单重设置的 DAIR 相比，双重设置的 DAIR 是一种可改变的手术技术，可显著降低感染复发的风险。
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