Karlsen Øystein E, Snorrason Finnur, Westberg Marianne
Department of Orthopaedic Surgery, Betanien Hospital, Skien, Norway.
Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo, Norway.
Hip Int. 2025 Jan;35(1):62-69. doi: 10.1177/11207000241295604. Epub 2024 Nov 19.
Prosthetic joint infection (PJI) is a much-feared complication in total joint arthroplasty. Debridement, antibiotics, irrigation and implant retention (DAIR) is often the preferred treatment in acute PJIs, but with varying results. The primary aim of this study was to evaluate the outcome of a high quality DAIR procedure performed according to a consistently applied surgical protocol in early postoperative and acute haematogenous PJIs in hip and knee, and secondary to study risk factors associated with failure.
We performed a prospective multicentre study to evaluate the effect of a standardised protocol-based surgical management (DAIR) emphasising a thorough debridement, followed by 6 weeks of antimicrobial therapy. Empiric parenteral antimicrobial treatment was administered until the results of susceptibility tests were available. No suppressive antimicrobial therapy was given after the 6-week treatment-period. Primary outcome measure was infection control at the 2-year follow-up.
A total of 99 patients from 8 Norwegian hospitals were found eligible and included in the study, and 82 patients were finally analysed. 69 of 82 patients (84% [CI, 76-92%]) were successfully treated with this treatment protocol. We found a reduced success rate when patients were treated with a DAIR procedure following an infected revision arthroplasty compared with an infected primary arthroplasty (11/17 (65 %) versus 58/65 (89 %), respectively ( = 0.02).
The success rate of a standardised DAIR procedure with a 6-week antimicrobial treatment was good in PJI following primary arthroplasties. The success rate following PJI in revision arthroplasty was poor, and other treatment options should be considered.
人工关节感染（PJI）是全关节置换术中令人恐惧的并发症。清创、抗生素治疗、冲洗及植入物保留（DAIR）通常是急性PJI的首选治疗方法，但效果各异。本研究的主要目的是评估在髋膝关节术后早期和急性血源性PJI中，按照一致应用的手术方案进行的高质量DAIR手术的结果，其次是研究与失败相关的危险因素。
我们进行了一项前瞻性多中心研究，以评估基于标准化方案的手术管理（DAIR）的效果，该方案强调彻底清创，随后进行6周的抗菌治疗。在药敏试验结果出来之前给予经验性肠外抗菌治疗。6周治疗期后不给予抑制性抗菌治疗。主要结局指标是2年随访时的感染控制情况。
挪威8家医院共有99例患者符合入选标准并纳入研究，最终分析了82例患者。82例患者中有69例（84%[CI，76-92%]）通过该治疗方案成功治愈。我们发现，与初次置换关节感染后接受DAIR手术的患者相比，翻修置换关节感染后接受DAIR手术的患者成功率较低（分别为11/17（65%）和58/65（89%）（=0.02）。
在初次置换关节后的PJI中，采用6周抗菌治疗的标准化DAIR手术成功率良好。翻修置换关节后PJI的成功率较低，应考虑其他治疗选择。
