Randall Shea E, Gocal Jakub K, Siddiqui Raheyma N, Brown Nicholas M, Schmitt Daniel R
Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois.
J Arthroplasty. 2025 Jun 3. doi: 10.1016/j.arth.2025.05.097.
Debridement, antibiotics, and irrigation with implant retention (DAIR) is a common treatment for acute or hematogenous periprosthetic joint infection (PJI) of the hip, offering lower short-term morbidity and mortality compared to two-stage revision. While there is an increased risk of postoperative dislocation in revision total hip arthroplasty (THA), limited data exist on the dislocation rate after DAIR. A few available studies investigated the rate of dislocation after DAIR for PJI in THA report rates up to 19.9%. The aim of this study was to identify the dislocation rate after DAIR for PJI in THA and risk factors for dislocation, such as component modifications and surgical approach.
A retrospective chart review identified patients treated with DAIR after infection of a primary or revision THA over a 20-year period with a minimum 1-year follow-up. Among DAIR patients, post-DAIR dislocations were recorded, along with demographic data, comorbidities, surgical approach, history of dislocation, number of post-DAIR dislocations, and any necessary follow-up surgical procedures related to the dislocation. Data were analyzed using a regression model to evaluate the dislocation rate after DAIR and significant risk factors were associated with dislocation.
Among 176 DAIR patients, 13 (7.4%) experienced dislocations. The 95% Wald-type confidence interval for dislocation rate was 3.5 to 11.3%. Patients with prior dislocations had 3.02 times higher odds of post-DAIR dislocation (odds ratio = 3.02, 95% confidence interval: 0.96 to 9.56; P = 0.06). Surgical approach or details of modular component exchange did not influence outcomes.
This study suggests an elevated risk of dislocation after DAIR used for the treatment of PJI in THA, but at a lower rate than previously reported in the literature. The results of this study are comparable to the historically reported results of dislocation rates after head and liner exchange for osteolysis.
清创、抗生素及保留植入物的冲洗术（DAIR）是治疗髋部急性或血源性人工关节感染（PJI）的常用方法，与两期翻修术相比，其短期发病率和死亡率更低。虽然翻修全髋关节置换术（THA）后术后脱位风险增加，但关于DAIR术后脱位率的数据有限。少数现有研究调查了THA中DAIR治疗PJI后的脱位率，报告的脱位率高达19.9%。本研究的目的是确定THA中DAIR治疗PJI后的脱位率以及脱位的危险因素，如假体组件修改和手术入路。
一项回顾性病历审查确定了在20年期间接受原发性或翻修THA感染后接受DAIR治疗且至少随访1年的患者。在接受DAIR治疗的患者中，记录了DAIR术后脱位情况，以及人口统计学数据、合并症、手术入路、脱位史、DAIR术后脱位次数以及与脱位相关的任何必要的后续手术程序。使用回归模型分析数据，以评估DAIR术后的脱位率，并确定与脱位相关的显著危险因素。
在176例接受DAIR治疗的患者中，13例（7.4%）发生了脱位。脱位率的95% Wald型置信区间为3.5%至11.3%。既往有脱位史的患者DAIR术后脱位的几率高出3.02倍（优势比 = 3.02，95%置信区间：0.96至9.56；P = 0.06）。手术入路或模块化组件更换细节不影响结果。
本研究表明，THA中用于治疗PJI的DAIR术后脱位风险增加，但低于文献中先前报道的发生率。本研究结果与历史上报道的因骨溶解进行股骨头和内衬更换后的脱位率结果相当。
