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Debridement, antibiotics and implant retention in early periprosthetic joint infection

Abstract

Introduction

Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome.

Methods

This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital.

Results

28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus.

Conclusions

The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.

Trial registration

ClinicalTrials.gov Identifier: NCT02087020.

Hip Int 2016; 26(2): 138 - 143

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/hipint.5000328

Authors

Magnus Bergkvist, Sebastian S. Mukka, Lars Johansson, Torbjörn E. Ahl, Arkan S. Sayed-Noor, Olof G. Sköldenberg, Thomas Eisler

Article History

Disclosures

Financial support: The Karolinska Institute supplied research grants for this study.
Conflict of interest: None.

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Authors

Affiliations

  •  Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden
  •  Department of Surgical and Perioperative Sciences, Umeå University, Umeå - Sweden
  •  Department of Infectious Diseases, Karolinska University Hospital, Stockholm - Sweden

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