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Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience.
J Arthroplasty 2017; 32(7):2248-2255JA

Abstract

BACKGROUND

Debridement-antibiotics-and-implant-retention (DAIR) may be considered a suitable surgical option in periprosthetic joint infections (PJIs) with soundly fixed prostheses, despite chronicity. This study aims to define the long-term outcome following DAIR in hip PJI.

METHODS

We reviewed all hip DAIRs performed between 1997 and 2013 (n = 122) to define long-term outcome and identify factors influencing it. Data recorded included patient demographics, medical history, type of DAIR performed (+/- exchange of modular components), and organisms identified. Outcome measures included complications and/or mortality rate, implant survivorship, and functional outcome (Oxford Hip Score).

RESULTS

Most DAIRs (67%) were of primary arthroplasties and 60% were performed within 6 weeks from the index arthroplasty. Infection eradication was achieved in 68% of the first DAIR procedure. In 32 cases, more than one DAIR was required. Infection eradication was achieved in 85% of the cases (104/122) with the (single or multiple) DAIR approach. The most common complication was PJI-persistence (15%), followed by dislocation (14%). Very good functional outcomes were obtained, especially in primary arthroplasties. All streptococcus infections were resolved with DAIR and had better outcome. Twenty-one hips have been revised (17%) to-date, 16 were for persistence of PJI. The 10-y implant survivorship was 77%. Early PJI and exchanging modular components at DAIR were independent factors for a 4-fold increased infection eradication and improved long-term implant survival.

CONCLUSION

DAIR is, therefore, a valuable option in the treatment of hip PJI, especially in the early postoperative period (≤6 weeks), with good outcomes. However, DAIR is associated with increased morbidity; further surgery may be necessary and instability may occur. Where possible, exchange of modular implants should be undertaken.

Authors+Show Affiliations

Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28385345

Citation

Grammatopoulos, George, et al. "Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience." The Journal of Arthroplasty, vol. 32, no. 7, 2017, pp. 2248-2255.
Grammatopoulos G, Kendrick B, McNally M, et al. Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. J Arthroplasty. 2017;32(7):2248-2255.
Grammatopoulos, G., Kendrick, B., McNally, M., Athanasou, N. A., Atkins, B., McLardy-Smith, P., ... Gundle, R. (2017). Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. The Journal of Arthroplasty, 32(7), pp. 2248-2255. doi:10.1016/j.arth.2017.02.066.
Grammatopoulos G, et al. Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. J Arthroplasty. 2017;32(7):2248-2255. PubMed PMID: 28385345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience. AU - Grammatopoulos,George, AU - Kendrick,Benjamin, AU - McNally,Martin, AU - Athanasou,Nicholas A, AU - Atkins,Bridget, AU - McLardy-Smith,Peter, AU - Taylor,Adrian, AU - Gundle,Roger, Y1 - 2017/03/06/ PY - 2016/11/03/received PY - 2017/01/27/revised PY - 2017/02/18/accepted PY - 2017/4/8/pubmed PY - 2018/3/6/medline PY - 2017/4/8/entrez KW - DAIR KW - hip KW - outcome KW - periprosthetic joint infection KW - revision SP - 2248 EP - 2255 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 7 N2 - BACKGROUND: Debridement-antibiotics-and-implant-retention (DAIR) may be considered a suitable surgical option in periprosthetic joint infections (PJIs) with soundly fixed prostheses, despite chronicity. This study aims to define the long-term outcome following DAIR in hip PJI. METHODS: We reviewed all hip DAIRs performed between 1997 and 2013 (n = 122) to define long-term outcome and identify factors influencing it. Data recorded included patient demographics, medical history, type of DAIR performed (+/- exchange of modular components), and organisms identified. Outcome measures included complications and/or mortality rate, implant survivorship, and functional outcome (Oxford Hip Score). RESULTS: Most DAIRs (67%) were of primary arthroplasties and 60% were performed within 6 weeks from the index arthroplasty. Infection eradication was achieved in 68% of the first DAIR procedure. In 32 cases, more than one DAIR was required. Infection eradication was achieved in 85% of the cases (104/122) with the (single or multiple) DAIR approach. The most common complication was PJI-persistence (15%), followed by dislocation (14%). Very good functional outcomes were obtained, especially in primary arthroplasties. All streptococcus infections were resolved with DAIR and had better outcome. Twenty-one hips have been revised (17%) to-date, 16 were for persistence of PJI. The 10-y implant survivorship was 77%. Early PJI and exchanging modular components at DAIR were independent factors for a 4-fold increased infection eradication and improved long-term implant survival. CONCLUSION: DAIR is, therefore, a valuable option in the treatment of hip PJI, especially in the early postoperative period (≤6 weeks), with good outcomes. However, DAIR is associated with increased morbidity; further surgery may be necessary and instability may occur. Where possible, exchange of modular implants should be undertaken. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28385345/Outcome_Following_Debridement_Antibiotics_and_Implant_Retention_in_Hip_Periprosthetic_Joint_Infection_An_18_Year_Experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30186-9 DB - PRIME DP - Unbound Medicine ER -