Risk factors affect success rate of debridement, antibiotics and implant retention (DAIR) in periprosthetic joint infect
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Arthroplasty
REVIEW
Open Access
Risk factors affect success rate of debridement, antibiotics and implant retention (DAIR) in periprosthetic joint infection Yihong Xu†, Liping Wang† and Weidong Xu*
Abstract Background: Periprosthetic joint infection (PJI) is the most devastating complication of joint replacement that seriously affects the quality of life and causes a heavy burden to the families and society. Due to shorter hospital stays, lower costs, improved joint function and less morbidity, a process of debridement, antibiotics and implant retention (DAIR) is recommended as the preferred treatment for acute periprosthetic joint infection. However, the factors that impact the success rate of DAIR remain controversial. This article evaluates the influential factors of DAIR and provides insights for orthopaedics surgeons to make optimal decisions to improve the success rate of DAIR. Conclusion: The poor general condition of patients, high preoperative C-reactive protein (CRP) level, repeated joint surgeries, and Methicillin-resistant Staphylococcus aureus (MRSA) infections may be associated with lower DAIR success rate. To the contrary, early surgery, radical debridement, exchange of removable components, washing with iodine and vacuum sealing drainage (VSD) may improve the success rate of DAIR. A sinus tract may not be absolutely contraindicated, but surgeons should treat it with caution. As there is no consensus on many issues, more high-quality research is required. Keywords: Risk factors, Success rate, DAIR, PJI
Introduction PJI is the most serious complication that contributes to more than a quarter of revision surgeries after joint arthroplasty [1, 2]. As people pay more attention to the PJI, the infection rate following arthroplasty is decreasing. However, the increase in the number of patients with prosthetic joints in recent decades has added to the absolute number of PJI cases [3, 4]. Recently, a review showed that, with more arthroplasty cases, the cost of revision surgery for infection has put greater pressure on healthcare budgets [5].
* Correspondence: [email protected] † Yihong Xu and Liping Wang contributed equally to this work. Department of Osteoarthropathy Surgery, Changhai Hospital, Shanghai 200433, China
The treatment of PJI aims to eradicate infection, relieve pain and improve function. The therapeutic regimens include simple antibiotic treatment, DAIR, one-stage revision or two-stage revision, arthrodesis and amputation [2, 6]. Due to the presence of biofilm on the surface of the prosthesis, the success rate of antibiotic therapy alone is very low. This treatment is reserved for patients who refuse surgery, or who are unable to undergo surgery due to their clinical circumstances such as concomitant illness, fragility, or advanced age [7]. One- or two-stage revision arthroplasty often place a burden on patients and families because of its significant injury and high cost. Arthrodesis and amputation are usually the last choice in clinical practice because of serious impairment of join
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