Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York; Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York.
J Arthroplasty. 2024 Nov;39(11):2849-2856. doi: 10.1016/j.arth.2024.05.065. Epub 2024 May 24.
Debridement, antibiotics, and implant retention (DAIR) are the mainstays surgical treatment for acute periprosthetic joint infection (PJI). However, reoperation following DAIR is common and the risk factors for DAIR failure remain unclear. This study aimed to assess the perioperative characteristics of patients who failed initial DAIR treatment.
A retrospective review was conducted on 83 patients who underwent DAIR for acute PJI within 3 months following index surgery from 2011 to 2022, with a minimum one-year follow-up. Surgical outcomes were categorized using the Musculoskeletal Infection Society outcome reporting tool (Tiers 1 to 4). Patient demographics, laboratory data, and perioperative outcomes were compared between patients who had failed (Tiers 3 and 4) (n = 32) and successful (Tiers 1 and 2) (n = 51) DAIR treatment. Logistic regression was also performed.
After logistic regression, Charlson Comorbidity Index (odds ratio [OR]: 1.57; P = .003), preoperative C-reactive protein (OR: 1.06; P = .014), synovial white blood cell (OR: 1.14; P = .008), and polymorphonuclear cell (PMN%) counts (OR: 1.05; P = .015) were independently associated with failed DAIR. Compared with total hip arthroplasty, total knee arthroplasty patients (OR: 6.08; P = .001) were at increased risk of DAIR failure. The type of organism and time from primary surgery were not correlated with DAIR failure.
Patients who had failed initial DAIR tended to have significantly higher Charlson Comorbidity Index, C-reactive protein, synovial white blood cell, and PMN%. The total knee arthroplasty DAIRs were more likely to fail than the total hip arthroplasty DAIRs. These characteristics should be considered when planning acute PJI management, as certain patients may be at higher risk for DAIR failure and may benefit from other surgical treatments.
III.
清创术、抗生素和植入物保留（DAIR）是治疗急性人工关节假体周围感染（PJI）的主要手术方法。然而，DAIR 后的再次手术很常见，DAIR 失败的风险因素仍不清楚。本研究旨在评估初次 DAIR 治疗失败患者的围手术期特征。
回顾性分析了 2011 年至 2022 年期间 83 例在指数手术后 3 个月内接受 DAIR 治疗的急性 PJI 患者的资料，所有患者均随访至少 1 年。采用肌肉骨骼感染学会（MUSIC）的手术结果报告工具（Tiers 1 至 4）对手术结果进行分类。比较 DAIR 治疗失败（Tiers 3 和 4）（n=32）和成功（Tiers 1 和 2）（n=51）患者的患者人口统计学、实验室数据和围手术期结果。还进行了逻辑回归分析。
经逻辑回归分析，Charlson 合并症指数（OR：1.57；P=0.003）、术前 C 反应蛋白（OR：1.06；P=0.014）、滑膜白细胞（OR：1.14；P=0.008）和多形核细胞（PMN%）计数（OR：1.05；P=0.015）与 DAIR 失败独立相关。与全髋关节置换术相比，全膝关节置换术患者（OR：6.08；P=0.001）DAIR 失败的风险增加。病原体类型和初次手术后的时间与 DAIR 失败无关。
初次 DAIR 治疗失败的患者往往有明显更高的 Charlson 合并症指数、C 反应蛋白、滑膜白细胞和 PMN%。全膝关节置换术 DAIR 比全髋关节置换术 DAIR 更有可能失败。在计划急性 PJI 管理时应考虑这些特征，因为某些患者 DAIR 失败的风险可能更高，可能受益于其他手术治疗。
III 级。
