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. 2020 Dec 15;5(4):e20.00110.
doi: 10.2106/JBJS.OA.20.00110. eCollection 2020 Oct-Dec.

Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention: An Observational Study of 575 Patients with Infection After Primary Total Hip Arthroplasty

Karin Svensson  1   2 , Ola Rolfson  1   2 , Emma Nauclér  2 , Stergios Lazarinis  3 , Olof Sköldenberg  4 , Jörg Schilcher  5 , Per-Erik Johanson  1   2 , Maziar Mohaddes  1   2 , Johan Kärrholm  1   2
Affiliations

Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention: An Observational Study of 575 Patients with Infection After Primary Total Hip Arthroplasty

Karin Svensson et al. JB JS Open Access. .

Abstract

Debridement, antibiotics, and implant retention (DAIR) is a surgical treatment for periprosthetic joint infection (PJI). DAIR is a desirable treatment option from an economic and patient perspective, if successful. The aim of this observational study was to compare the rates of success, defined as no additional reoperations due to PJI, between DAIR with exchange of modular components and DAIR without exchange in patients who had first-time PJI after primary total hip arthroplasty (THA).

Methods: Patients with PJI at the site of a primary THA who were treated with DAIR in Sweden between January 1, 2009, and December 31, 2016, were identified in the Swedish Hip Arthroplasty Register. Supplementary questionnaires were sent to orthopaedic departments for additional variables of interest related to PJI. The primary end point was another reoperation due to PJI within 2 years after the first-time DAIR. DAIR with exchange was compared with DAIR without exchange using Kaplan-Meier survival analysis and Cox regression analysis.

Results: A total of 575 patients treated with DAIR for a first-time PJI at the site of a primary THA were analyzed; 364 underwent component exchange and 211 did not. The exchange of components was associated with a lower rate of reoperations due to PJI after DAIR (28.0%) compared with non-exchange (44.1%). The Kaplan-Meier implant survival estimate for exchange was 71.4% (95% confidence interval [CI] = 66.9% to 76.3%) compared with 55.5% (95% CI = 49.1% to 62.7%) for non-exchange. With the analysis adjusted for confounders, DAIR with exchange was associated with a significantly decreased risk of another reoperation due to PJI compared with non-exchange (hazard ratio [HR] = 0.51 [95% CI = 0.38 to 0.68]).

Conclusions: In patients with a first-time PJI at the site of a primary THA, DAIR with exchange of modular components was superior to non-exchange DAIR. Surgeons should strive to exchange components when they perform DAIR, but there is a need to further identify how DAIR best should be practiced and which patients benefit from it.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: This research was funded by regional research grants (ALFGBG-719961) and the Doktor Felix Neubergh Foundation. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSOA/A230).

Figures

Fig. 1
Fig. 1
Flow diagram of study inclusion.
Fig. 2
Fig. 2
Survival analysis, using Kaplan-Meier estimates, with reoperations due to infection within 2 years after DAIR (with and without the exchange of modular components) as the end point. The shaded areas represent the 95% CIs.
Fig. 3
Fig. 3
Survival analysis, using Kaplan-Meier estimates, with revision of bone-anchored components due to infection within 2 years after DAIR (with and without exchange of modular components) as the end point. The shaded areas represent the 95% CIs.
See this image and copyright information in PMC

References

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