Efficacy of Debridement, Antibiotics, and Implant Retention in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

Abstract

Background: Periprosthetic joint infection (PJI) remains a challenging complication in total joint arthroplasty, often leading to the necessity of revision surgery. The treatment strategy of debridement, antibiotics, and implant retention (DAIR) is widely used for the management of acute PJI, with variable success rates across studies. We aimed to examine the effectiveness of DAIR in the management of PJI after primary hip and knee arthroplasties.

Methods: We searched MEDLINE, Scopus, Web of Science, and reference lists of relevant studies from 2013 to 2023. Studies that provided quantitative data on the outcomes of DAIR for hip or knee PJIs were included. The primary outcome was the failure rate of DAIR. The secondary outcome included failure rates by joint type (hip or knee). The study used a random effects model for meta-analysis.

Results: The search generated 572 studies, of which 81 studies were included. The failure rate for DAIR ranged from 0 to 84.4%, with an overall pooled estimate of 35.9% (95% confidence interval [CI]: 23.9 to 48.0). Further analysis revealed remarkable variation in failure rates depending on the timing of the infection: 34.2% (95% CI: 28.8 to 39.6) for acute/early postoperative infections, 39.1% for acute hematogenous infections, and 73.6% for late chronic infections. The failure rates were also stratified by joint type, revealing higher failure rates in knee arthroplasties compared to hip. Staphylococcus aureus was the most common microorganism linked to DAIR failure. Diabetes mellitus and cardiovascular disease were the prevalent comorbidities in these patients.

Conclusions: These findings highlight that the DAIR approach is a viable option for the treatment of PJI, with acceptable failure rates, especially for acute PJI. Furthermore, this systematic review provides insights into variables that can aid in refining patient selection and treatment protocols for managing PJI.

Keywords: DAIR; hip arthroplasty; joint arthroplasty; knee arthroplasty; periprosthetic joint infection.