Debridement, Antibiotics and Implant Retention for Early Periprosthetic Infections of the Hip: Outcomes and Influencing Factors.

Purpose: Debridement, antibiotics and implant retention (DAIR) is commonly performed and widely accepted for the treatment of acute infections following hip arthroplasty. The aims of this study were to: i) determine the DAIR success rate in treating acute postoperative and hematogenous periprosthetic infections of the hip at a tertiary hospital, ii) identify possible outcome predictors, and iii) analyze clinical and radiological outcomes.

Materials And Methods: We retrospectively reviewed cases of acute postoperative (≤3 months from index procedure) and hematogenous periprosthetic infections following total hip arthroplasty treated with DAIR at our hospital between 2004 and 2015. Overall, 26 hips (25 patients) were included in the study, with a mean age of 72.5 years (standard deviation [SD], 9.4). The mean follow-up was 48.5 months (SD, 43.7). Several variables (e.g., patient characteristics, infection type, surgery parameters) were examined to evaluate their influence on outcomes; functional and radiographic outcomes were assessed.

Results: The overall success rate of DAIR was 26.9%. The male sex was associated with treatment failure (=0.005) and debridement performed by a surgeon in hip unit with success (=0.028). DAIR failure increased in patients with chronic pulmonary disease (=0.059) and steroid therapy (=0.062). Symptom duration of <11 days until DAIR yielded a better infection eradication rate (=0.068). The mean postoperative Harris Hip Score was 74.2 (SD, 16.6).

Conclusion: DAIR, despite being used frequently, had a high failure rate in our series. Outcomes improved if an experienced hip arthroplasty surgeon performed the surgery. Patient comorbidities and symptom duration should be considered for decision-making.