Shaik Arfaz, Chakrapani Arjun S, Hayat Umar, Ahmed Ameen, Selvarajan Dheeraj Panchaksharam, Shaik Nafsheen
Trauma and Orthopaedics, Croydon University Hospital, London, GBR.
Trauma and Orthopaedics, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, GBR.
Cureus. 2025 May 21;17(5):e84591. doi: 10.7759/cureus.84591. eCollection 2025 May.
This study aimed to determine how well debridement, antibiotics, and implant retention (DAIR) work for treating infections after total hip and knee replacements. Specifically, it compared the success of this treatment in resolving infection, improving function, and preventing complications when the infection occurred early (within three months) versus late (three months to 12 months) after the joint replacement surgery.
The objective of the study is to evaluate DAIR's efficacy in resolving periprosthetic joint infections (PJIs) post-THAs (total hip arthroplasties) and TKAs (total knee arthroplasties), focusing on infection resolution, functional recovery, and complications.
This retrospective cohort study reviewed 37 patients (25 TKA, 12 THA) treated with DAIR for PJIs at the UK tertiary centre (2019-2023). PJIs were diagnosed using the 2018 International Consensus Meeting (ICM) criteria.Outcomes (infection status, range of motion (ROM), pain, complications) were assessed via electronic health records, with a mean follow-up of 12.8 months for TKA and 10.4 months for THA. The statistical analysis tool used was IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).
DAIR successfully treated infection in 73.9% of infected total knee replacements and 58.3% of infected total hip replacements (p=0.576). Early infections (within three months) responded better to DAIR (88% for TKA, 91.7% for THA) compared to late infections (0% success, p<0.01). Complications arose in nine TKA and eight THA patients (p=0.157), including three deaths, which were more frequent in late infections (p=0.04). Following DAIR, there were significant reductions in average C-reactive protein levels for both TKA (from 134.5 to 16.9 mg/L, p<0.01) and THA (from 147.1 to 41.6 mg/L, p = 0.03).
DAIR achieved infection resolution in 73.9% of TKA and 58.3% of THA cases, particularly when performed within three months of infection onset, while late infections (>three months) had 0% success, emphasising the need for timely intervention and patient selection.
本研究旨在确定清创、抗生素和植入物保留（DAIR）在治疗全髋关节和膝关节置换术后感染方面的效果。具体而言，比较了这种治疗方法在关节置换手术后早期（三个月内）与晚期（三个月至十二个月）发生感染时，在解决感染、改善功能和预防并发症方面的成功率。
本研究的目的是评估DAIR在解决全髋关节置换术（THA）和全膝关节置换术（TKA）后假体周围关节感染（PJI）方面的疗效，重点关注感染的解决、功能恢复和并发症。
这项回顾性队列研究对英国三级中心（2019 - 2023年）接受DAIR治疗PJI的37例患者（25例TKA，12例THA）进行了回顾。使用2018年国际共识会议（ICM）标准诊断PJI。通过电子健康记录评估结果（感染状态、活动范围（ROM）、疼痛、并发症），TKA的平均随访时间为12.8个月，THA为10.4个月。使用的统计分析工具是IBM SPSS Statistics for Windows，版本26（2019年发布；IBM公司，美国纽约州阿蒙克）。
DAIR成功治疗了73.9%的感染全膝关节置换术和58.3%的感染全髋关节置换术（p = 0.576）。与晚期感染（成功率为0%，p < 0.01）相比，早期感染（三个月内）对DAIR的反应更好（TKA为88%，THA为91.7%）。9例TKA患者和8例THA患者出现并发症（p = 0.157），包括3例死亡，晚期感染中并发症更常见（p = 0.04）。DAIR治疗后，TKA（从134.5降至16.9 mg/L，p < 0.01）和THA（从147.1降至41.6 mg/L，p = 0.03）的平均C反应蛋白水平均显著降低。
DAIR在73.9%的TKA病例和58.3%的THA病例中实现了感染的解决，特别是在感染发生后三个月内进行时，而晚期感染（超过三个月）的成功率为0%，强调了及时干预和患者选择的必要性。
