Tarabichi Saad, Verhey Jens T, Haglin Jack M, Horne Carly, Deckey David G, Clarke Henry D, Bingham Joshua S, Spangehl Mark J
Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
J Arthroplasty. 2025 May 23. doi: 10.1016/j.arth.2025.05.069.
Recently, the double debridement, antibiotics, and implant retention (DAIR) using antibiotic-loaded bone cement beads for the treatment of acute periprosthetic joint infection (PJI) has gained traction following promising reports in the literature. The purpose of this study was to examine the clinical outcomes of this protocol and identify predictors of failure following completion of a double DAIR procedure.
This retrospective study identified all patients who underwent a double DAIR protocol for the management of acute PJI (≤ 28 days from either index arthroplasty or symptom onset) at a single institution. Acute PJI was defined using the 2013 Musculoskeletal Infection Society criteria. All patients had a minimum of 1-year follow-up. Treatment failure was defined as reoperation secondary to infection, PJI-related mortality, or signs of persistent infection at the latest follow-up.
There were 128 patients (69 knees and 59 hips) included in the final analyses. At a mean follow-up time of 4.8 ± 3.9 years, 86.1% of infected primaries and 71.4% of infected revision patients were found to have experienced treatment success. When adjusting for covariates, multivariate regression analyses identified revision arthroplasty (odds ratio [OR], 7.6; P = 0.002), acute hematogenous PJI (OR, 7.1; P = 0.048), and positive culture at second debridement (OR, 5.0; P = 0.039) as independent predictors of failure following completion of a double DAIR procedure.
We found that 86.1% of infected primaries and 71.4% of infected revisions that received a double DAIR for acute PJI were infection-free at the latest follow-up. On regression analyses, revision arthroplasty, acute hematogenous PJI, and a positive culture at second debridement were found to be independent predictors of treatment failure in this patient population.
最近，在文献报道取得良好效果后，使用载抗生素骨水泥珠的双重清创、抗生素及植入物保留（DAIR）方法治疗急性人工关节周围感染（PJI）受到了关注。本研究的目的是检验该方案的临床疗效，并确定双重DAIR程序完成后治疗失败的预测因素。
这项回顾性研究纳入了在单一机构接受双重DAIR方案治疗急性PJI（自初次关节置换或症状出现起≤28天）的所有患者。急性PJI采用2013年肌肉骨骼感染学会的标准进行定义。所有患者至少随访1年。治疗失败定义为因感染再次手术、PJI相关死亡率或在最近一次随访时存在持续感染迹象。
最终分析纳入了128例患者（69例膝关节和59例髋关节）。平均随访时间为4.8±3.9年，发现86.1%的初次感染患者和71.4%的翻修感染患者治疗成功。在对协变量进行调整后，多因素回归分析确定翻修关节成形术（比值比[OR]，7.6；P = 0.002）、急性血源性PJI（OR，7.1；P = 0.048）以及第二次清创时培养结果为阳性（OR，5.0；P = 0.039）是双重DAIR程序完成后治疗失败的独立预测因素。
我们发现，接受双重DAIR治疗急性PJI的86.1%的初次感染患者和71.4%的翻修感染患者在最近一次随访时无感染。回归分析发现，翻修关节成形术、急性血源性PJI以及第二次清创时培养结果为阳性是该患者群体治疗失败的独立预测因素。
