Debridement, Antibiotics and Implant Retention for Early Periprosthetic Infections of the Hip: Outcomes and Influencing Factors = Debridement, Antibiotics and Implant Retention for Early Periprosthetic Infections of the Hip: Outcomes and Influencing Factors

다국어 초록 (Multilingual Abstract)

Purpose: Debridement, antibiotics and implant retention (DAIR) is commonly performed and widely accepted for the treatment of acute infections following hip arthroplasty. The aims of this study were to: i) determine the DAIR success rate in treating acute postoperative and hematogenous periprosthetic infections of the hip at a tertiary hospital, ii) identify possible outcome predictors, and iii) analyze clinical and radiological outcomes.
Materials and Methods: We retrospectively reviewed cases of acute postoperative (≤3 months from index procedure) and hematogenous periprosthetic infections following total hip arthroplasty treated with DAIR at our hospital between 2004 and 2015. Overall, 26 hips (25 patients) were included in the study, with a mean age of 72.5 years (standard deviation [SD], 9.4). The mean follow-up was 48.5 months (SD, 43.7). Several variables (e.g., patient characteristics, infection type, surgery parameters) were examined to evaluate their influence on outcomes; functional and radiographic outcomes were assessed.
Results: The overall success rate of DAIR was 26.9%. The male sex was associated with treatment failure (P=0.005) and debridement performed by a surgeon in hip unit with success (P=0.028). DAIR failure increased in patients with chronic pulmonary disease (P=0.059) and steroid therapy (P=0.062). Symptom duration of <11 days until DAIR yielded a better infection eradication rate (P=0.068). The mean postoperative Harris Hip Score was 74.2 (SD, 16.6).
Conclusion: DAIR, despite being used frequently, had a high failure rate in our series. Outcomes improved if an experienced hip arthroplasty surgeon performed the surgery. Patient comorbidities and symptom duration should be considered for decision-making.

참고문헌 (Reference)

1 Gruen TA, "“Modes of failure”of cemented stem-type femoral components: a radiographic analysis of loosening" (141) : 17-27, 1979

2 Charlson M, "Validation of a combined comorbidity index" 47 : 1245-1251, 1994

3 Crockarell JR, "Treatment of infection with débridement and retention of the components following hip arthroplasty" 80 : 1306-1313, 1998

4 Bozic KJ, "The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization" 87 : 1746-1751, 2005

5 Zmistowski BM, "Recurrent periprosthetic joint infection after irrigation and debridement with component retention is most often due to identical organisms" 31 (31): 148-151, 2016

6 DeLee JG, "Radiological demarcation of cemented sockets in total hip replacement" (121) : 20-32, 1976

7 Pulido L, "Periprosthetic joint infection : the incidence, timing, and predisposing factors" 466 : 1710-1715, 2008

8 Marculescu CE, "Outcome of prosthetic joint infections treated with debridement and retention of components" 42 : 471-478, 2006

9 Byren I, "One hundred and twelve infected arthroplasties treated with ‘DAIR’(debridement, antibiotics and implant retention) : antibiotic duration and outcome" 63 : 1264-1271, 2009

10 Parvizi J, "New definition for periprosthetic joint infection : from the Workgroup of the Musculoskeletal Infection Society" 469 : 2992-2994, 2011

11 Tornero E, "KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics" 21 : 786-, 2015

12 Azzam KA, "Irrigation and debridement in the management of prosthetic joint infection : traditional indications revisited" 25 : 1022-1027, 2010

13 Triantafyllopoulos GK, "Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome" 39 : 1203-1209, 2015

14 Koyonos L, "Infection control rate of irrigation and débridement for periprosthetic joint infection" 469 : 3043-3048, 2011

15 Tsukayama DT, "Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections" 78 : 512-523, 1996

16 Klouche S, "Infected total hip arthroplasty treated by an irrigation-debridement/component retention protocol. A prospective study in a 12-case series with minimum 2 years’ follow-up" 97 : 134-138, 2011

17 Dale H, "Increasing risk of prosthetic joint infection after total hip arthroplasty" 83 : 449-458, 2012

18 Betz M, "Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus" 39 : 397-401, 2015

19 Grammatopoulos G, "Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip : a casecontrol study" 99 : 614-622, 2017

20 Fehring TK, "Failure of irrigation and débridement for early postoperative periprosthetic infection" 471 : 250-257, 2013

21 Manley M, "Effect of volume on total hip arthroplasty revision rates in the United States Medicare population" 90 : 2446-2451, 2008

22 Westberg M, "Early prosthetic joint infections treated with debridement and implant retention : 38 primary hip arthroplasties prospectively recorded and followed for median 4 years" 83 : 227-232, 2012

23 Aboltins C, "Early prosthetic hip joint infection treated with debridement, prosthesis retention and biofilm-active antibiotics : functional outcomes, quality of life and complications" 43 : 810-815, 2013

24 Bergkvist M, "Debridement, antibiotics and implant retention in early periprosthetic joint infection" 26 : 138-143, 2016

25 Sendi P, "Debridement and implant retention in the management of hip periprosthetic joint infection : outcomes following guided and rapid treatment at a single centre" 99 : 330-336, 2017

26 Del Pozo JL, "Clinical practice. Infection associated with prosthetic joints" 361 : 787-794, 2009

27 Achermann Y, "Characteristics and treatment outcomes of 69 cases with early prosthetic joint infections of the hip and knee" 42 : 511-519, 2014

28 Sukeik M, "Aggressive early débridement for treatment of acutely infected cemented total hip arthroplasty" 470 : 3164-3170, 2012

29 Fink B, "A standardized regimen for the treatment of acute postoperative infections and acute hematogenous infections associated with hip and knee arthroplasties" 32 : 1255-1261, 2017

30 Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation" 40 : 373-383, 1987