Svensson Karin, Rolfson Ola, Nauclér Emma, Lazarinis Stergios, Sköldenberg Olof, Schilcher Jörg, Johanson Per-Erik, Mohaddes Maziar, Kärrholm Johan
Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
JB JS Open Access. 2020 Dec 15;5(4). doi: 10.2106/JBJS.OA.20.00110. eCollection 2020 Oct-Dec.
Debridement, antibiotics, and implant retention (DAIR) is a surgical treatment for periprosthetic joint infection (PJI). DAIR is a desirable treatment option from an economic and patient perspective, if successful. The aim of this observational study was to compare the rates of success, defined as no additional reoperations due to PJI, between DAIR with exchange of modular components and DAIR without exchange in patients who had first-time PJI after primary total hip arthroplasty (THA).
Patients with PJI at the site of a primary THA who were treated with DAIR in Sweden between January 1, 2009, and December 31, 2016, were identified in the Swedish Hip Arthroplasty Register. Supplementary questionnaires were sent to orthopaedic departments for additional variables of interest related to PJI. The primary end point was another reoperation due to PJI within 2 years after the first-time DAIR. DAIR with exchange was compared with DAIR without exchange using Kaplan-Meier survival analysis and Cox regression analysis.
A total of 575 patients treated with DAIR for a first-time PJI at the site of a primary THA were analyzed; 364 underwent component exchange and 211 did not. The exchange of components was associated with a lower rate of reoperations due to PJI after DAIR (28.0%) compared with non-exchange (44.1%). The Kaplan-Meier implant survival estimate for exchange was 71.4% (95% confidence interval [CI] = 66.9% to 76.3%) compared with 55.5% (95% CI = 49.1% to 62.7%) for non-exchange. With the analysis adjusted for confounders, DAIR with exchange was associated with a significantly decreased risk of another reoperation due to PJI compared with non-exchange (hazard ratio [HR] = 0.51 [95% CI = 0.38 to 0.68]).
In patients with a first-time PJI at the site of a primary THA, DAIR with exchange of modular components was superior to non-exchange DAIR. Surgeons should strive to exchange components when they perform DAIR, but there is a need to further identify how DAIR best should be practiced and which patients benefit from it.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
清创、抗生素及植入物保留（DAIR）是治疗人工关节周围感染（PJI）的一种手术方法。从经济和患者角度来看，如果成功，DAIR是一种理想的治疗选择。本观察性研究的目的是比较初次全髋关节置换术（THA）后首次发生PJI的患者中，进行模块化组件置换的DAIR与未进行置换的DAIR在成功率（定义为不因PJI进行额外再次手术）方面的差异。
在瑞典髋关节置换登记处识别出2009年1月1日至2016年12月31日期间在瑞典接受DAIR治疗的初次THA部位发生PJI的患者。向骨科科室发送补充问卷以获取与PJI相关的其他感兴趣变量。主要终点是首次DAIR后2年内因PJI进行的再次手术。使用Kaplan-Meier生存分析和Cox回归分析比较进行置换的DAIR与未进行置换的DAIR。
共分析了575例在初次THA部位因首次PJI接受DAIR治疗的患者；364例进行了组件置换，211例未进行置换。与未置换相比，置换组件与DAIR后因PJI进行再次手术的发生率较低（28.0%）相关。进行置换的Kaplan-Meier植入物生存估计为71.4%（95%置信区间[CI]=66.9%至76.3%），而未置换的为55.5%（95%CI=49.1%至62.7%）。在对混杂因素进行调整分析后，与未置换相比，进行置换的DAIR因PJI进行再次手术的风险显著降低（风险比[HR]=0.51[95%CI=0.38至0.68]）。
在初次THA部位首次发生PJI的患者中，进行模块化组件置换的DAIR优于未进行置换的DAIR。外科医生在进行DAIR时应努力置换组件，但需要进一步确定DAIR的最佳实施方式以及哪些患者能从中受益。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
