AI Article Synopsis
- - This study analyzed the outcomes of 83 patients who underwent debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) to identify factors related to treatment failure.
- - Key findings indicated that higher scores on the Charlson Comorbidity Index and elevated levels of C-reactive protein, synovial white blood cells, and PMN% were significantly linked to unsuccessful DAIR outcomes, particularly in total knee arthroplasty patients.
- - The conclusions suggest that understanding these risk factors is crucial for effectively managing PJI, as some patients may require different surgical approaches instead of DAIR.
Article Abstract
Background: Debridement, antibiotics, and implant retention (DAIR) are the mainstays surgical treatment for acute periprosthetic joint infection (PJI). However, reoperation following DAIR is common and the risk factors for DAIR failure remain unclear. This study aimed to assess the perioperative characteristics of patients who failed initial DAIR treatment.
Methods: A retrospective review was conducted on 83 patients who underwent DAIR for acute PJI within 3 months following index surgery from 2011 to 2022, with a minimum one-year follow-up. Surgical outcomes were categorized using the Musculoskeletal Infection Society outcome reporting tool (Tiers 1 to 4). Patient demographics, laboratory data, and perioperative outcomes were compared between patients who had failed (Tiers 3 and 4) (n = 32) and successful (Tiers 1 and 2) (n = 51) DAIR treatment. Logistic regression was also performed.
Results: After logistic regression, Charlson Comorbidity Index (odds ratio [OR]: 1.57; P = .003), preoperative C-reactive protein (OR: 1.06; P = .014), synovial white blood cell (OR: 1.14; P = .008), and polymorphonuclear cell (PMN%) counts (OR: 1.05; P = .015) were independently associated with failed DAIR. Compared with total hip arthroplasty, total knee arthroplasty patients (OR: 6.08; P = .001) were at increased risk of DAIR failure. The type of organism and time from primary surgery were not correlated with DAIR failure.
Conclusions: Patients who had failed initial DAIR tended to have significantly higher Charlson Comorbidity Index, C-reactive protein, synovial white blood cell, and PMN%. The total knee arthroplasty DAIRs were more likely to fail than the total hip arthroplasty DAIRs. These characteristics should be considered when planning acute PJI management, as certain patients may be at higher risk for DAIR failure and may benefit from other surgical treatments.
Level Of Evidence: III.
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| http://dx.doi.org/10.1016/j.arth.2024.05.065 | DOI Listing |
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Article Synopsis
- The study evaluated the prognosis of implant-related infections in patients aged 65 and older after hip fractures, focusing on various pre-surgical, surgical, and microbiological factors affecting outcomes.
- Out of 80 patients included, nearly half experienced treatment failure, while 37.5% died within a year, with acute infections linked to higher mortality rates and treatment failures.
- The findings suggest that using antibiofilm-controlling surgery and antibiotics significantly improves treatment outcomes, particularly for frail patients dealing with acute infections post-surgery.
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