Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Bone Joint J. 2024 Dec 1;106-B(12):1377-1384. doi: 10.1302/0301-620X.106B12.BJJ-2024-0282.R1.
Periprosthetic joint infection (PJI) represents a complex challenge in orthopaedic surgery associated with substantial morbidity and healthcare expenditures. The debridement, antibiotics, and implant retention (DAIR) protocol is a viable treatment, offering several advantages over exchange arthroplasty. With the evolution of treatment strategies, considerable efforts have been directed towards enhancing the efficacy of DAIR, including the development of a phased debridement protocol for acute PJI management. This article provides an in-depth analysis of DAIR, presenting the outcomes of single-stage, two-stage, and repeated DAIR procedures. It delves into the challenges faced, including patient heterogeneity, pathogen identification, variability in surgical techniques, and antibiotics selection. Moreover, critical factors that influence the decision-making process between single- and two-stage DAIR protocols are addressed, including team composition, timing of the intervention, antibiotic regimens, and both anatomical and implant-related considerations. By providing a comprehensive overview of DAIR protocols and their clinical implications, this annotation aims to elucidate the advancements, challenges, and potential future directions in the application of DAIR for PJI management. It is intended to equip clinicians with the insights required to effectively navigate the complexities of implementing DAIR strategies, thereby facilitating informed decision-making for optimizing patient outcomes.
人工关节周围感染（PJI）是骨科手术中面临的一项复杂挑战，会导致严重的发病率和医疗保健支出。清创术、抗生素保留和关节置换术（DAIR）是一种可行的治疗方法，与关节置换术相比具有多项优势。随着治疗策略的发展，人们已经做出了大量努力来提高 DAIR 的疗效，包括为急性 PJI 管理制定分期清创方案。本文深入分析了 DAIR，介绍了单阶段、双阶段和重复 DAIR 手术的结果。文章探讨了所面临的挑战，包括患者异质性、病原体鉴定、手术技术的可变性以及抗生素的选择。此外，还讨论了影响单阶段和双阶段 DAIR 方案决策的关键因素，包括团队组成、干预时机、抗生素方案以及解剖和植入物相关考虑因素。通过全面概述 DAIR 方案及其临床意义，本注释旨在阐明 PJI 管理中 DAIR 的应用的进展、挑战和潜在未来方向。旨在为临床医生提供有效应对实施 DAIR 策略的复杂性所需的见解，从而为优化患者结果做出明智决策提供支持。
