Published in:
01-09-2018 | Prosthetic Joint Infection (S Nodzo and N Frisch, section editors)
Indications and Guidelines for Debridement and Implant Retention for Periprosthetic Hip and Knee Infection
Authors:
Douglas A. Zaruta, Bowen Qiu, Andrew Y. Liu, Benjamin F. Ricciardi
Published in:
Current Reviews in Musculoskeletal Medicine
|
Issue 3/2018
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Abstract
Purpose of Review
Prosthetic joint infection is one the most common causes of revision surgery after hip or knee replacement. Debridement and implant retention (DAIR) is one method of treating these infections; however, significant controversy exists. The purpose of our review was to describe current knowledge about indications, intraoperative/postoperative patient management, and outcomes of DAIR.
Recent Findings
Patient selection affects the success of DAIR. Medical comorbidities, duration of symptoms, and nature of infectious organism all influence outcomes. Intraoperative techniques such as open arthrotomy, extensive debridement, copious irrigation, and exchange of modular parts remain current standards for DAIR. Postoperative administration of antibiotics tailored to operative cultures remains critical. Antibiotic suppression may increase the success of DAIR.
Summary
DAIR provides reasonable infection eradication between 50 and 80% with improved outcomes in appropriately selected patients. More research is needed on the use of adjuvant therapies intraoperatively and the role of postoperative antibiotic suppression.