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PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
Acta Biomed. 2022 Mar 10;92(S3):e2021572. doi: 10.23750/abm.v92iS3.12603.
Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty. In early infection, within four to twelve weeks from surgery, debridement, antibiotics and implant retention (DAIR) can be the initial treatment. The aim of this study is to report our case series and review current concepts reported in the literature about this topic.
This was an observational cohort study that included 7 patients managed with DAIR for PJI following primary total hip replacement (THR) between 2014 and 2020. Inclusion criteria were a primary THR, direct anterior or lateral approach, DAIR procedure, and PJI. Exclusion criteria were a PJI following a revision total hip replacement or hemiarthroplasty, posterolateral approach, 1-stage revision, 2-stage revision, and Girdlestone procedure without prior DAIR. For each patient demographic characteristics, laboratory values, microorganisms involved, antibiotic therapy and outcome at one-year follow-up were registered.
The mean duration between THR and DAIR was 19 days. In all cases only one DAIR procedure was performed. Most infections were caused by Staphylococcus aureus (4 cases) [one methicillin resistant (MRSA)]. The other infections were caused by Streptococcus agalactiae, Staphylococcus coagulase negative and Escherichia coli. At the final follow-up, the procedure was considered as successful in 6 out of 7 patients (85%). The one with unsuccessful outcome underwent to a two-stage revision.
Our results were comparable with those of a recent systematic review of the literature. Factors that have been postulated to influence the outcome of DAIR in the management of PJIs include the timing and numbers of debridement, the exchange of components, the responsible microorganism and the duration of antibiotic treatment. In conclusion, the outcomes following DAIR are better as the indications are refined and risk factors identified. PJI prevention remains the key but the current literature still lacks well documented and effective PJI prevention protocols. (www.actabiomedica.it).
人工关节置换术后感染（PJI）是全髋关节置换术后最具挑战性的并发症之一。在早期感染（术后 4 至 12 周内）中，可以采用清创术、抗生素和保留假体（DAIR）作为初始治疗。本研究旨在报告我们的病例系列，并回顾目前文献中关于该主题的概念。
这是一项观察性队列研究，纳入了 2014 年至 2020 年间因初次全髋关节置换术后发生 PJI 而接受 DAIR 治疗的 7 例患者。纳入标准为初次全髋关节置换、直接前侧或外侧入路、DAIR 手术和 PJI。排除标准为翻修全髋关节置换或半髋关节置换后发生的 PJI、后外侧入路、1 期翻修、2 期翻修和未先行 DAIR 的 Girdlestone 手术。对每位患者的人口统计学特征、实验室值、涉及的微生物、抗生素治疗和 1 年随访结果进行了登记。
初次全髋关节置换与 DAIR 之间的平均时间为 19 天。所有病例均仅行 1 次 DAIR 手术。大多数感染由金黄色葡萄球菌（4 例）[1 例耐甲氧西林金黄色葡萄球菌（MRSA）]引起。其他感染由无乳链球菌、凝固酶阴性葡萄球菌和大肠杆菌引起。最终随访时，7 例患者中有 6 例（85%）手术被认为成功。1 例手术失败的患者进行了 2 期翻修。
我们的结果与最近的文献系统回顾结果相当。影响 DAIR 在 PJI 管理中疗效的因素包括清创的时机和次数、假体更换、致病微生物和抗生素治疗的持续时间。总之，随着适应症的细化和危险因素的确定，DAIR 后的结果更好。预防 PJI 仍然是关键，但目前文献中仍然缺乏经过充分记录和有效的 PJI 预防方案。（www.actabiomedica.it）。
