Zellner Alberto Alfieri, Watzlawik Niclas, Roos Jonas, Hischebeth Gunnar Thorben Rembert, Prangenberg Christian, Franz Alexander, Fröschen Frank Sebastian
Department. of Orthopedics and Trauma Surgery, University Hospital of Bonn, 53127, Bonn, Germany.
Institute of Medical Microbiology, Immunology and Parasitology, University Clinic of Bonn, Bonn, Germany.
J Orthop Surg Res. 2025 Jul 18;20(1):676. doi: 10.1186/s13018-025-06117-z.
Periprosthetic joint infections (PJIs) are severe complications following total joint arthroplasty, with significant implications for implant longevity and patient quality of life. The debridement, antibiotics, irrigation, and implant retention (DAIR) procedure is a key strategy for managing acute PJIs while preserving the prosthesis. However, its success is highly variable, influenced by factors such as pathogen virulence and patient-specific risks. We set out to evaluate revision-free implant survival and potential risk factors influencing outcome at our institution.
This retrospective, single-center study analyzed a total of 110 patients (60 hip and 50 knee) treated for acute periprosthetic joint infections (PJI) with DAIR between 2017 and 2022. Exchange of mobile parts was undertaken in all cases. Postoperative management followed a standardized protocol, consisting of two weeks of intravenous antibiotics followed by four weeks of oral antibiotics. Clinical and radiological follow-ups were conducted at predefined intervals, assessing implant stability and signs of reinfection. Comprehensive patient data, including demographics, infection markers, microbiology, implant type, and prior surgical history, were collected and analyzed statistically.
Overall, 23.6% (n = 26) of patients were lost to follow-up. Of the remaining 84 patients, we were able to detect 31 cases of tier 1 success according to Fillingham outcome criteria, which represents 36.9%. The patients in whom DAIR failed, tended to be older, have more comorbidities and showed a higher total cell count in preoperative joint aspiration. Furthermore, prior revision arthroplasty was associated with a significantly higher failure rate in the knee group.
A preoperative assessment of the likelihood of DAIR success should be undertaken for each patient. For this assessment, our data indicates to look at patient specific factors such as age, ASA score, revision implant, and preoperative cell count. These aspects may enhance risk evaluation and support the selection of an alternative treatment strategy when appropriate.
人工关节周围感染（PJI）是全关节置换术后的严重并发症，对植入物的使用寿命和患者生活质量有重大影响。清创、抗生素治疗、冲洗和保留植入物（DAIR）手术是在保留假体的同时管理急性PJI的关键策略。然而，其成功率差异很大，受病原体毒力和患者特定风险等因素影响。我们着手评估我院无翻修植入物的生存率以及影响结果的潜在风险因素。
这项回顾性单中心研究分析了2017年至2022年间接受DAIR治疗急性人工关节周围感染（PJI）的110例患者（60例髋关节和50例膝关节）。所有病例均进行了活动部件的更换。术后管理遵循标准化方案，包括两周的静脉抗生素治疗，随后四周的口服抗生素治疗。在预定时间间隔进行临床和影像学随访，评估植入物稳定性和再感染迹象。收集包括人口统计学、感染标志物、微生物学、植入物类型和既往手术史在内的综合患者数据，并进行统计分析。
总体而言，23.6%（n = 26）的患者失访。在其余84例患者中，根据Fillingham结果标准，我们能够检测到31例1级成功病例，占36.9%。DAIR失败的患者往往年龄较大，合并症较多，术前关节穿刺的总细胞计数较高。此外，既往翻修关节成形术与膝关节组的失败率显著较高相关。
应为每位患者进行DAIR成功可能性的术前评估。对于该评估，我们的数据表明要考虑患者特定因素，如年龄、ASA评分、翻修植入物和术前细胞计数。这些方面可能会加强风险评估，并在适当时支持选择替代治疗策略。
