Frear Andrew J, Shannon Michael F, Sadhwani Shaan, Kamson Anthony O, Smith Clair, Patterson Charity G, Wong Victoria R, Plate Frank Johannes, Urish Kenneth L
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15203, USA.
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, PA 17109, USA.
J Bone Jt Infect. 2025 Jul 23;10(4):225-235. doi: 10.5194/jbji-10-225-2025. eCollection 2025.
In periprosthetic joint infection (PJI) following total knee arthroplasty (TKA), debridement, antibiotics, and implant retention (DAIR) is a common procedure with a high rate of failure. Timing of infection can be used to stratify acute PJI into acute postoperative, intermediate, and hematogenous infections. Potential differences in prognosis between classifications remain unclear. This investigation assessed the current overall failure of DAIR procedures, compared DAIR failure between three types of acute PJI, and analyzed DAIR outcomes in an "optimal" cohort of patients with a minimal number of medical comorbidities. This retrospective study compared 122 patients with acute TKA PJI who underwent DAIR between 2016 and 2022. Categorization was based on timing between index TKA and PJI diagnosis, with 6 weeks termed postoperative ( 43), 6 weeks to 1 year termed intermediate ( 19), and 1 year termed hematogenous ( 60). The primary outcome was DAIR failure, defined as reoperation for PJI. Subgroup analysis was performed after removing patients with high-risk comorbidities. The overall failure rate was 42 %; 78.4 % of failures occurred within 1 year. No significant differences in the failure rate were found between PJI types at any time point. At 1 year, 58 % postoperative, 58 % intermediate, and 77 % hematogenous cases remained failure-free ( 0.09). Failure rates of 45 % postoperative, 44 % intermediate, and 36 % hematogenous cases were seen in the optimal cohort, without significant differences. DAIR failure for acute TKA PJI is high. Although no differences in failure rates were observed based on the PJI type, DAIR failure trended lower for the hematogenous group in this study. Outcomes for DAIR appear similar regardless of the PJI type in optimal patients.
在全膝关节置换术（TKA）后发生的人工关节周围感染（PJI）中，清创、抗生素治疗及植入物保留（DAIR）是一种常见的手术，但失败率较高。感染时间可用于将急性PJI分为急性术后感染、中期感染和血源性感染。不同分类之间预后的潜在差异仍不明确。本研究评估了目前DAIR手术的总体失败情况，比较了三种类型急性PJI之间的DAIR失败情况，并分析了合并症最少的“最佳”患者队列中的DAIR结果。这项回顾性研究比较了2016年至2022年间接受DAIR治疗的122例急性TKA PJI患者。分类基于初次TKA与PJI诊断之间的时间，术后6周以内（43例）称为术后感染，6周至1年（19例）称为中期感染，1年以后（60例）称为血源性感染。主要结局为DAIR失败，定义为因PJI再次手术。排除高危合并症患者后进行亚组分析。总体失败率为42%；78.4%的失败发生在1年内。在任何时间点，不同类型PJI之间的失败率均无显著差异。1年时，术后感染、中期感染和血源性感染病例中分别有58%、58%和77%未出现失败（P=0.09）。在最佳队列中，术后感染、中期感染和血源性感染病例的失败率分别为45%、44%和36%，无显著差异。急性TKA PJI的DAIR失败率较高。尽管未观察到基于PJI类型的失败率差异，但在本研究中血源性感染组的DAIR失败率有降低趋势。在最佳患者中，无论PJI类型如何，DAIR的结果似乎相似。
