Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection: Results of 126 Primary Hip Arthroplasties at Extended Follow-Up of Seven Years.

Abstract

Background: There is renewed interest in debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infections (PJIs). The purpose of this study was to assess the results of single DAIRs for acute PJI after primary hip arthroplasty in a large series with extended follow-up.

Methods: We identified 126 hips (108 total hip arthroplasties, 18 hemiarthroplasties) with acute PJIs treated with DAIR followed by chronic antibiotic suppression between 2000 and 2021 at a single institution. Acute postoperative PJI was defined as infection within four weeks of primary hip arthroplasty, and acute hematogenous PJI was defined as infection occurring more than four weeks after primary hip arthroplasty with symptoms for less than 21 days. The mean age was 67 years, 44% were women, and the mean body mass index was 34. Kaplan-Meier survivorship analyses were performed. The mean follow-up was seven years.

Results: Survivorship free of reinfection was 80% at one year, 79% at two years, and 77% at five years. There was no difference in survivorship free of reinfection between early postoperative and acute hematogenous PJIs (P = 0.1). McPherson Host Grade C was predictive of reinfection (hazard ratio 5, P = 0.03). Reinfection was caused by the original organism in 33% of hips. The median time to reinfection was 13 days. Survivorship free of any revision was 82% at five years. Indications for revision included recurrent PJI (91%), dislocation (5%), and aseptic failures (5%).

Conclusions: In this large series of acute PJIs after primary hip arthroplasties treated with a single DAIR, infection-free survival was 77% at five years. Poor host status predicted reinfection. With a rigorous definition of acute PJI, success was markedly improved at extended follow-up compared to many historical series.