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. 2025 Jul 18;20(1):676.
doi: 10.1186/s13018-025-06117-z.

Mid-term results after DAIR for patients with acute periprosthetic joint infections of the hip or knee

Alberto Alfieri Zellner  1 , Niclas Watzlawik  1 , Jonas Roos  1 , Gunnar Thorben Rembert Hischebeth  2 , Christian Prangenberg  1 , Alexander Franz  1   3 , Frank Sebastian Fröschen  4
Affiliations

Mid-term results after DAIR for patients with acute periprosthetic joint infections of the hip or knee

Alberto Alfieri Zellner et al. J Orthop Surg Res. .

Abstract

Introduction: Periprosthetic joint infections (PJIs) are severe complications following total joint arthroplasty, with significant implications for implant longevity and patient quality of life. The debridement, antibiotics, irrigation, and implant retention (DAIR) procedure is a key strategy for managing acute PJIs while preserving the prosthesis. However, its success is highly variable, influenced by factors such as pathogen virulence and patient-specific risks. We set out to evaluate revision-free implant survival and potential risk factors influencing outcome at our institution.

Materials and methods: This retrospective, single-center study analyzed a total of 110 patients (60 hip and 50 knee) treated for acute periprosthetic joint infections (PJI) with DAIR between 2017 and 2022. Exchange of mobile parts was undertaken in all cases. Postoperative management followed a standardized protocol, consisting of two weeks of intravenous antibiotics followed by four weeks of oral antibiotics. Clinical and radiological follow-ups were conducted at predefined intervals, assessing implant stability and signs of reinfection. Comprehensive patient data, including demographics, infection markers, microbiology, implant type, and prior surgical history, were collected and analyzed statistically.

Results: Overall, 23.6% (n = 26) of patients were lost to follow-up. Of the remaining 84 patients, we were able to detect 31 cases of tier 1 success according to Fillingham outcome criteria, which represents 36.9%. The patients in whom DAIR failed, tended to be older, have more comorbidities and showed a higher total cell count in preoperative joint aspiration. Furthermore, prior revision arthroplasty was associated with a significantly higher failure rate in the knee group.

Conclusion: A preoperative assessment of the likelihood of DAIR success should be undertaken for each patient. For this assessment, our data indicates to look at patient specific factors such as age, ASA score, revision implant, and preoperative cell count. These aspects may enhance risk evaluation and support the selection of an alternative treatment strategy when appropriate.

Keywords: Acute periprosthetic infection; Arthroplasty; DAIR; PJI; Revision-free survival.

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Conflict of interest statement

Declarations. Informed consent statement: Patient consent was waived due to retrospective design. Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Ethic Board (University of Bonn Ethics Committee, No. 2024-164-BO/22) (Approved Date: 15 April 2024). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier-Survival analysis with the endpoint revision-free implant survival for patients following debridement, antibiotics and implant retention of the total hip arthroplasty and total knee arthroplasty groups (ntotal=110; nhip=60, nknee=50)
Fig. 2
Fig. 2
Revision-free implant survival in patients with total hip arthroplasty. (ntotal=60; nprimay=21, nrevision=39)
Fig. 3
Fig. 3
Revision-free implant survival in patients with total knee arthroplasty (ntotal=49; nTKAprimary=19, nTKArevision=30)
Fig. 4
Fig. 4
Revision-free implant for subgroup analysis according to type of infection following the Tsukayama classification in hip and knee
See this image and copyright information in PMC

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