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Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study.
Bone Joint J 2017; 99-B(5):614-622BJ

Abstract

AIMS

Advocates of debridement, antibiotics and implant retention (DAIR) in hip periprosthetic joint infection (PJI) argue that a procedure not disturbing a sound prosthesis-bone interface is likely to lead to better survival and functional outcome compared with revision. This case-control study aims were to compare outcome of DAIRs for infected primary total hip arthroplasty (THA) with outcomes following primary THA and two-stage revision of infected primary THAs.

PATIENTS AND METHODS

We retrospectively reviewed all DAIRs, performed for confirmed infected primary hip arthropasty (n = 82) at out institution, between 1997 and 2013. Data recorded included full patient information and type of surgery. Outcome measures included complications, mortality, implant survivorship and functional outcome. Outcome was compared with two control groups matched for gender and age; a cohort of primary THAs (n = 120) and a cohort of two-stage revisions for infection (n = 66).

RESULTS

Mean age at DAIR was 69 years (33 to 87) and mean follow-up was eight years (2 to 17; standard deviation (sd) 5). A total of 52 (63%) of DAIRs were for early PJI (less than six weeks). Greater success in the eradication of infection with DAIR was identified with early PJI, comprising an interval less than a week between onset of symptoms and exchange of modular components with the DAIR procedure. Eradication of infection, complications and re-operation rates were similar in the DAIR and two-stage revision groups. For hips with successful eradication of infection with DAIR, the five-year survival (98%; 95% confidence interval (CI) 94 to 100) was similar to the primary THA group (98%; 95% CI 95 to 100) (n = 43; p = 0.3). The DAIR group had inferior mean Oxford Hip Scores (OHS) (38; 12 to 48) compared with the primary THA group (42; 15 to 48) (p = 0.02) but a significantly better mean OHS compared with the two-stage revision group (31; 0 to 48) (p = 0.008). Patients who required only one DAIR for eradication of infection had a similar mean OHS (41; 20 to 48) to the primary THA group (p = 0.2).

CONCLUSION

The DAIR procedure is associated with a similar complication rate and ability to eradicate infection as two-stage revision. This study emphasises the need for exchange of modular components for improved chances of eradication of infection. This is the first study showing that DAIR is better than a two-stage revision regarding functional outcome. Cite this article: Bone Joint J 2017;99-B:614-22.

Authors+Show Affiliations

Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28455470

Citation

Grammatopoulos, G, et al. "Functional Outcome of Debridement, Antibiotics and Implant Retention in Periprosthetic Joint Infection Involving the Hip: a Case-control Study." The Bone & Joint Journal, vol. 99-B, no. 5, 2017, pp. 614-622.
Grammatopoulos G, Bolduc ME, Atkins BL, et al. Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study. Bone Joint J. 2017;99-B(5):614-622.
Grammatopoulos, G., Bolduc, M. E., Atkins, B. L., Kendrick, B. J. L., McLardy-Smith, P., Murray, D. W., ... Taylor, A. H. (2017). Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study. The Bone & Joint Journal, 99-B(5), pp. 614-622. doi:10.1302/0301-620X.99B5.BJJ-2016-0562.R2.
Grammatopoulos G, et al. Functional Outcome of Debridement, Antibiotics and Implant Retention in Periprosthetic Joint Infection Involving the Hip: a Case-control Study. Bone Joint J. 2017;99-B(5):614-622. PubMed PMID: 28455470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: a case-control study. AU - Grammatopoulos,G, AU - Bolduc,M-E, AU - Atkins,B L, AU - Kendrick,B J L, AU - McLardy-Smith,P, AU - Murray,D W, AU - Gundle,R, AU - Taylor,A H, PY - 2016/06/10/received PY - 2017/01/20/accepted PY - 2017/4/30/entrez PY - 2017/4/30/pubmed PY - 2017/8/2/medline KW - Debridement, antibiotics and implant retention KW - Hip arthroplasty KW - Periprosthetic joint infection SP - 614 EP - 622 JF - The bone & joint journal JO - Bone Joint J VL - 99-B IS - 5 N2 - AIMS: Advocates of debridement, antibiotics and implant retention (DAIR) in hip periprosthetic joint infection (PJI) argue that a procedure not disturbing a sound prosthesis-bone interface is likely to lead to better survival and functional outcome compared with revision. This case-control study aims were to compare outcome of DAIRs for infected primary total hip arthroplasty (THA) with outcomes following primary THA and two-stage revision of infected primary THAs. PATIENTS AND METHODS: We retrospectively reviewed all DAIRs, performed for confirmed infected primary hip arthropasty (n = 82) at out institution, between 1997 and 2013. Data recorded included full patient information and type of surgery. Outcome measures included complications, mortality, implant survivorship and functional outcome. Outcome was compared with two control groups matched for gender and age; a cohort of primary THAs (n = 120) and a cohort of two-stage revisions for infection (n = 66). RESULTS: Mean age at DAIR was 69 years (33 to 87) and mean follow-up was eight years (2 to 17; standard deviation (sd) 5). A total of 52 (63%) of DAIRs were for early PJI (less than six weeks). Greater success in the eradication of infection with DAIR was identified with early PJI, comprising an interval less than a week between onset of symptoms and exchange of modular components with the DAIR procedure. Eradication of infection, complications and re-operation rates were similar in the DAIR and two-stage revision groups. For hips with successful eradication of infection with DAIR, the five-year survival (98%; 95% confidence interval (CI) 94 to 100) was similar to the primary THA group (98%; 95% CI 95 to 100) (n = 43; p = 0.3). The DAIR group had inferior mean Oxford Hip Scores (OHS) (38; 12 to 48) compared with the primary THA group (42; 15 to 48) (p = 0.02) but a significantly better mean OHS compared with the two-stage revision group (31; 0 to 48) (p = 0.008). Patients who required only one DAIR for eradication of infection had a similar mean OHS (41; 20 to 48) to the primary THA group (p = 0.2). CONCLUSION: The DAIR procedure is associated with a similar complication rate and ability to eradicate infection as two-stage revision. This study emphasises the need for exchange of modular components for improved chances of eradication of infection. This is the first study showing that DAIR is better than a two-stage revision regarding functional outcome. Cite this article: Bone Joint J 2017;99-B:614-22. SN - 2049-4408 UR - https://www.unboundmedicine.com/medline/citation/28455470/Functional_outcome_of_debridement_antibiotics_and_implant_retention_in_periprosthetic_joint_infection_involving_the_hip:_a_case_control_study_ L2 - https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.99B5.BJJ-2016-0562.R2?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -