Kristensen Nicolai K, Callary Stuart A, Nelson Renjy, Harries Dylan, Lorimer Michelle, Smith Paul, Campbell David
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Orthopedic Surgery, Central Hospital Unit, Silkeborg and Viborg, Denmark; Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark.
Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.
J Arthroplasty. 2025 Jul;40(7):1852-1859.e1. doi: 10.1016/j.arth.2024.12.016. Epub 2024 Dec 20.
Periprosthetic joint infection is a devastating and severe complication of total knee arthroplasty (TKA). The Australian Joint Registry reports an increasing number of debridement, antibiotics, and implant retention (DAIR) procedures, underscoring the need to comprehend outcomes for informed treatment decisions. This study aimed to determine the outcome of DAIR procedures, evaluate time since primary TKA, and identify patient-related factors associated with DAIR failure.
We conducted a national registry-based cohort study using data from 1999 to 2021. We included 8,642 revisions for infection, of which 5,178 were DAIR procedures (60%) predominantly performed within four weeks of primary surgery. We assessed the outcomes using Kaplan-Meier estimates and Cox proportional hazard models.
Post-DAIR, the cumulative percent second revision cumulative percent revision in the DAIR cohort was 20% at year 1, increasing to 36% at year 17. Early DAIR procedures had a lower post-DAIR revision rate until three months after primary TKA. A DAIR performed within 2 weeks after primary TKA compared to three months had an hazard ratio [HR]: 0.74 (95% CI [confidence interval]: 0.62 to 0.88). After four weeks, the post-DAIR revision rate did not deteriorate and was similar for further time periods from the primary. Men had an age-adjusted HR of 1.28 (95% CI: 1.14 to 1.43, P < 0.001) for DAIR failure compared to women. There was a significantly higher HR for post-DAIR revision in patients younger than 75 years of age, compared to patients aged ≥ 75 years.
These findings underscore the critical influence of patient-related factors and the timing of DAIR treatment on the need for additional surgery. DAIR after four weeks had an increased risk of subsequent revision, and older women undergoing early DAIR interventions had more favorable outcomes. Understanding these nuances aids in optimizing periprosthetic joint infection management strategies, offering insights for decision-making.
人工关节周围感染是全膝关节置换术（TKA）一种严重且具有破坏性的并发症。澳大利亚关节注册机构报告称，清创、抗生素及植入物保留（DAIR）手术的数量在不断增加，这凸显了了解手术结果以做出明智治疗决策的必要性。本研究旨在确定DAIR手术的结果，评估初次TKA后的时间，并确定与DAIR手术失败相关的患者因素。
我们利用1999年至2021年的数据进行了一项基于全国注册机构的队列研究。我们纳入了8642例因感染进行的翻修手术，其中5178例（60%）为DAIR手术，主要在初次手术后四周内进行。我们使用Kaplan-Meier估计法和Cox比例风险模型评估结果。
在DAIR手术后，DAIR队列中第二次翻修的累积百分比在第1年为20%，在第17年增至36%。在初次TKA后三个月内，早期DAIR手术的DAIR术后翻修率较低。与三个月时相比，在初次TKA后2周内进行DAIR手术的风险比[HR]为0.74（95%置信区间[CI]：0.62至0.88）。四周后，DAIR术后翻修率没有恶化，且与初次手术的后续时间段相似。与女性相比，男性DAIR手术失败的年龄调整后HR为1.28（95%CI：1.14至1.43，P<0.001）。与年龄≥75岁的患者相比，年龄<75岁的患者DAIR术后翻修的HR显著更高。
这些发现强调了患者相关因素和DAIR治疗时机对额外手术需求的关键影响。四周后的DAIR手术后续翻修风险增加，而接受早期DAIR干预的老年女性有更有利的结果。了解这些细微差别有助于优化人工关节周围感染管理策略，为决策提供见解。
