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Introduction: Periprosthetic joint infection (PJI) is a common cause for reoperation after knee and hip arthroplasty surgery. Debridement, antibiotics and implant retention (DAIR) is recommended in early infections (< 4 weeks) and stable implants. Aims: To define the success rate of DAIR in early infections and to identify predictors for success. Material and methods: In a retrospective cohort study we included patients with hip- or knee arthroplasties reoperated for an early PJI at Danderyd Hospital 2007-2012. Logistic regression analysis was used to identify risk factors affecting success rate. Primary outcome variable was the success of the DAIR treatment. Secondary outcome variable vas risk factors for treatment failure.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Periprosthetic joint infection | Patient treated with 'Debridement, antibiotics and implant retention' for early postoperative periprosthetic joint infection at Danderyd Hospital between 2007-01-01 and 2012-12-01 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Debridement, antibiotics and implant retention | Procedure | DAIR treatment protocol embodies an extensive surgical debridement and a radical excision of infected tissue. This is followed by exchange of modular components (articulating surfaces of the implant such as the femoral head, acetabular liner in total hip arthroplasty and the tibial insert, the polyethylene meniscus, in total knee arthroplasty). The wound is then copiously irrigated (> 9 litre) with 0.9 % sodium chloride and then closed. |
| Measure | Description | Time Frame |
|---|---|---|
| Successful treatment | The success rate, in terms of infection eradication without additional surgical methods, of debridement, antibiotics and implant retention in early postoperative periprosthetic joint infection.. | 6 year |
| Measure | Description | Time Frame |
|---|---|---|
| Risk factors for treatment failure | Analyze of potential risk factors for treatment failure, age, gender, comorbidities i.e type 1 or 2 diabetes mellitus, renal insufficiency, dementia, systemic inflammatory disease, local or systemic infection, American Society of Anesthesiologists classification, virulence of infecting microbial, hospital stay, typ of arthroplasty, revision arthroplasty, and administration of antibiotics prior to debridement, antibiotics and implant retention treatment. |
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Inclusion Criteria:
Patients treated with DAIR for early postoperative periprosthetic joint infection after knee- or hip arthroplasty surgery (<4-6 weeks postoperatively) at our institution between 2007-01-01 and 2012-12-01.
Exclusion Criteria:
Chronic or late presenting periprosthetic joint infection (>6 weeks postoperatively), acute hematogenous periprosthetic joint infection, when the periprosthetic joint infection diagnosis criteria according to American Musculoskeletal Infection Society (MSIS) 2011 definition of PJI definitions were not fulfilled and when the initial surgical treatment was with other treatment protocol than DAIR including one-stage revision and two -stage revision
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Danderyd Hospital is a university hospital affiliated with the Karolinska Institute and is one of the four emergency hospitals in Stockholm, with a catchment area of approximately 500.000 inhabitants. The index cohort was extracted from the local in-hospital surgery database at the Department of Orthopaedic Surgery using ICD 10 coding and surgical intervention coding for PJI treatment.
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| Name | Affiliation | Role |
|---|---|---|
| Olof G Skoldenberg, MD,PhD | Orthopaedic department, Danderyds hospital | Principal Investigator |
| Sebastian S Mukka, MD | Orthopaedic department, Danderyds hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Danderyd Hospital | Stockholm | Danderyd | 182 88 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15483283 | Background | Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004 Oct 14;351(16):1645-54. doi: 10.1056/NEJMra040181. No abstract available. | |
| 26868114 | Derived | Bergkvist M, Mukka SS, Johansson L, Ahl TE, Sayed-Noor AS, Skoldenberg OG, Eisler T. Debridement, antibiotics and implant retention in early periprosthetic joint infection. Hip Int. 2016 Mar-Apr;26(2):138-43. doi: 10.5301/hipint.5000328. Epub 2016 Feb 8. |
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| ID | Term |
|---|---|
| D016459 | Prosthesis-Related Infections |
| D007592 | Joint Diseases |
| ID | Term |
|---|---|
| D007239 | Infections |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D003646 | Debridement |
| D000900 | Anti-Bacterial Agents |
| ID | Term |
|---|---|
| D013514 | Surgical Procedures, Operative |
| D000890 | Anti-Infective Agents |
| D045506 | Therapeutic Uses |
| D020228 | Pharmacologic Actions |
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|
| 6 year |
| D009140 | Musculoskeletal Diseases |
| D020164 | Chemical Actions and Uses |