Alamino Leonel Pérez, Olaran María Agustina, Nieto Xavier Maya, Garabano German, Pesciallo César
Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
Eur J Orthop Surg Traumatol. 2025 Jul 22;35(1):316. doi: 10.1007/s00590-025-04438-7.
The aim of this study was to evaluate the success rate in cases of acute prosthetic joint infection (PJI) of the knee or hip treated with debridement, antibiotics, and implant retention (DAIR), and to identify risk factors associated with treatment failure.
A retrospective study was conducted involving adult patients treated with DAIR for PJI of the knee or hip, with a minimum follow-up of 12 months. Success was defined as the absence of signs of recurrence or reinfection 12 months post-DAIR. Cases reviewed for infectious reasons or those on chronic suppressive antibiotic therapy were considered failures. The need for an additional DAIR within 10 days of the first was not classified as failure.
The final cohort included 62 patients, of whom 35 (56.4%) were male. A total of 45 (72.6%) achieved success with a single DAIR procedure. Failure was significantly more common in patients with polymicrobial infections (58.8% vs. 13.3%; p < 0.01; OR 8.7 [2.3-32.2]) and those with hip PJI (88.2% vs. 48.9%; p = 0.008; OR 7.1 [1.4-33.6]). The presence of persistent wound drainage was associated with a higher risk of failure (52.9% vs. 17.7%; p = 0.002; OR 5.2 [1.6-18.4]). The survival rate at the end of the study was 93.6%.
DAIR is an effective option for treating acute PJIs of the knee and hip. The presence of a persistent wound drainage, polymicrobial infections, and hip arthroplasty are independent risk factors for treatment failure.
本研究旨在评估采用清创、抗生素和保留植入物（DAIR）治疗的膝关节或髋关节急性人工关节感染（PJI）病例的成功率，并确定与治疗失败相关的风险因素。
进行一项回顾性研究，纳入接受DAIR治疗膝关节或髋关节PJI的成年患者，随访至少12个月。成功定义为DAIR术后12个月无复发或再感染迹象。因感染原因复查的病例或接受慢性抑制性抗生素治疗的病例被视为治疗失败。首次DAIR后10天内需要再次进行DAIR的情况不被归类为失败。
最终队列包括62例患者，其中35例（56.4%）为男性。共有45例（72.6%）通过单次DAIR手术获得成功。多重微生物感染患者（58.8%对13.3%；p < 0.01；OR 8.7 [2.3 - 32.2]）和髋关节PJI患者（88.2%对48.9%；p = 0.008；OR 7.1 [1.4 - 33.6]）治疗失败明显更为常见。持续伤口引流与更高的失败风险相关（52.9%对17.7%；p = 0.002；OR 5.2 [1.6 - 18.4]）。研究结束时的生存率为93.6%。
DAIR是治疗膝关节和髋关节急性PJI的有效选择。持续伤口引流、多重微生物感染和髋关节置换术是治疗失败的独立风险因素。
