Quinn Jonathan, van Duren Bernard H, Berber Reshid, Higgins Mark, Matar Hosam E, Manktelow Andrew R, Bloch Benjamin V
Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Arthroplast Today. 2025 Jan 21;31:101593. doi: 10.1016/j.artd.2024.101593. eCollection 2025 Feb.
Debridement, antibiotics and implant retention (DAIR) procedure is well-established as a management option for acute periprosthetic joint infection (PJI). We investigated the infection eradication rates of DAIR procedures at our center using Bactisure wound lavage.
A retrospective consecutive review of DAIR procedures for hip and knee PJI was conducted between 2018 and 2023 with a minimum 12-month follow-up at our tertiary revision arthroplasty center. Suitability for DAIR was determined at the multi-disciplinary team discussion. Revision procedures and patients with previous PJI were excluded. Patient, surgical, microbiological, and postoperative data (minimum 12 months) was reviewed. The use of Bactisure was in addition to routine surgical management.
During the study period, 76 DAIR procedures were performed (55 knees and 21 hips). Bactisure was used in 26 cases (20 knees and 6 hips). Overall, 6 of 26 Bactisure DAIRs failed (23%), while 14 of 50 non-Bactisure DAIRs failed (28%), which did not demonstrate statistical significance ( = .644). Subgroup analysis demonstrated no difference in knee DAIRs ( = .761) but a trend toward significance in hip DAIRs ( = .262). No adverse effects of Bactisure use were noted intraoperatively or postoperatively. DAIR failed in 50% of diabetic patients compared to 20% of nondiabetic patients ( = .015). Age, body mass index, and organism identification did not influence outcome.
The addition of Bactisure to DAIR procedures did not demonstrate statistically significant improvement of successful eradication of infection, but a potential trend toward significance was noted in hip DAIRs. Diabetic patients failed DAIR in 50% of cases. The in-vivo outcomes of Bactisure use during DAIR procedures remain inconclusive.
清创、抗生素与植入物保留（DAIR）手术是治疗急性人工关节周围感染（PJI）的一种成熟的管理选择。我们在本中心使用Bactisure伤口灌洗法研究了DAIR手术的感染根除率。
对2018年至2023年间在我们的三级翻修关节置换中心进行的髋部和膝部PJI的DAIR手术进行回顾性连续分析，随访时间至少为12个月。在多学科团队讨论中确定是否适合进行DAIR手术。排除翻修手术和既往有PJI的患者。回顾患者、手术、微生物学和术后数据（至少12个月）。Bactisure的使用是在常规手术管理之外。
在研究期间，共进行了76例DAIR手术（55例膝部和21例髋部）。26例（20例膝部和6例髋部）使用了Bactisure。总体而言，26例使用Bactisure的DAIR手术中有6例失败（23%），而50例未使用Bactisure的DAIR手术中有14例失败（28%），差异无统计学意义（P = 0.644）。亚组分析显示膝部DAIR手术无差异（P = 0.761），但髋部DAIR手术有显著差异趋势（P = 0.262）。术中或术后未发现使用Bactisure的不良反应。50%的糖尿病患者DAIR手术失败，而非糖尿病患者为20%（P = 0.015）。年龄、体重指数和病原体鉴定不影响结果。
在DAIR手术中添加Bactisure并未显示出在成功根除感染方面有统计学意义的改善，但在髋部DAIR手术中观察到有显著差异的潜在趋势。50%的糖尿病患者DAIR手术失败。在DAIR手术中使用Bactisure的体内结果仍无定论。
