Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands.
Bone Joint J. 2022 Apr;104-B(4):464-471. doi: 10.1302/0301-620X.104B4.BJJ-2021-1264.R1.
Debridement, antibiotics, and implant retention (DAIR) is a widely accepted form of surgical treatment for patients with an early periprosthetic joint infection (PJI) after primary arthroplasty. The outcome of DAIR after revision arthroplasty, however, has not been reported. The aim of this study was to report the success rate of DAIR after revision arthroplasty with a follow-up of two years.
This retrospective study, conducted at the Sint Maartenskliniek, Nijmegen, the Netherlands, included 88 patients who underwent DAIR within 90 days of revision total hip or total knee arthroplasty between 2012 and 2019. Details of the surgical procedures and PJI were collected. Univariate analysis and a subgroup analysis of the culture-positive group were performed. Kaplan-Meier survivorship curves were constructed.
The overall success rate of DAIR, with respect to the retention of components and the cure of infection, was 68% after two years. DAIR performed with an interval of > 30 days after the index revision procedure (odds ratio (OR) 0.24 (95% confidence interval (CI) 0.08 to 0.72); p = 0.008), a repeated DAIR within 90 days (OR 0.37 (95% CI 0.14 to 0.97); p = 0.040), and the use of an immunosuppressive agent (OR 0.13 (95% CI 0.02 to 0.67); p = 0.012) were associated with a significantly reduced success rate. In the culture-positive group, a mismatch between the antibiotic treatment and the susceptibility of the organism was associated with a significantly lower success rate (OR 0.13 (95% CI 0.03 to 0.62); p = 0.007).
DAIR is an acceptable form of surgical treatment for patients with a suspected early PJI after revision arthroplasty of the hip or knee. DAIRs performed after a prolonged interval, multiple DAIRs, and antibiotic mismatches were significantly associated with an increased risk of failure. Optimization of the host immune response and the prevention of antibiotic mismatch are modifiable factors that may improve the outcome. The high rate of mismatches was an important finding, underlining the need for a review of the local microbiological data, which might improve the outcome. Cite this article: 2022;104-B(4):464-471.
清创、抗生素和保留植入物（DAIR）是一种广泛接受的治疗初次关节置换术后早期人工关节周围感染（PJI）的手术方法。然而，翻修术后 DAIR 的结果尚未见报道。本研究的目的是报告在翻修术后 2 年随访时，DAIR 的成功率。
这项回顾性研究在荷兰奈梅亨的圣马田斯诊所进行，纳入了 2012 年至 2019 年间在翻修全髋关节或全膝关节置换术后 90 天内接受 DAIR 的 88 例患者。收集了手术过程和 PJI 的详细信息。进行了单变量分析和阳性培养组的亚组分析。绘制 Kaplan-Meier 生存曲线。
在 2 年时，保留关节假体和治愈感染方面，DAIR 的总体成功率为 68%。与索引翻修术后间隔>30 天进行 DAIR（比值比（OR）0.24（95%置信区间（CI）0.08 至 0.72）；p=0.008）、90 天内重复 DAIR（OR 0.37（95%CI 0.14 至 0.97）；p=0.040）和使用免疫抑制剂（OR 0.13（95%CI 0.02 至 0.67）；p=0.012）与显著降低的成功率相关。在阳性培养组中，抗生素治疗与病原体敏感性不匹配与成功率显著降低相关（OR 0.13（95%CI 0.03 至 0.62）；p=0.007）。
DAIR 是髋关节或膝关节翻修术后疑似早期 PJI 患者的一种可接受的手术治疗方法。间隔时间较长、多次 DAIR 和抗生素不匹配与失败风险增加显著相关。优化宿主免疫反应和预防抗生素不匹配是可能改善结果的可改变因素。抗生素不匹配的高发生率是一个重要的发现，这强调了需要审查当地的微生物学数据，这可能会改善结果。
2022；104-B（4）：464-471。
