Procedure to treat infection after TJA may yield positive outcomes

William George Hamilton

PARK CITY, Utah — Use of debridement, antibiotics and implant retention may be beneficial in the treatment of infection after total joint arthroplasty, according to a presenter at the Joint Arthroplasty Mountain Meeting.

Compared with two-stage exchange, use of debridement, antibiotics and implant retention (DAIR) for treatment of infection after TJA is easier for the patient and surgeon. It also has lower morbidity and cost, according to William George Hamilton, MD. However, he noted lower rate of eradication of infection with the treatment is the biggest downside, historically, compared with a two-stage exchange.

“[DAIR] should be [performed] early,” Hamilton said in his presentation. “There is some gray area on what early is defined as, but most of these publications seem to use the 4-week time frame. That is either 4 weeks postop or 4 weeks from the onset of symptoms.”

Patients undergoing DAIR should have a stable implant, and Hamilton noted performing DAIR earlier, exchanging the modular components, having a better host and longer postoperative antibiotics may lead to a higher success rate. However, patients with chronic renal failure, liver cirrhosis, rheumatoid arthritis and higher sedimentation or C-reactive protein rates may reduce the rate of success.

Hamilton noted it has been recommended that DAIR be performed on an urgent basis when the patient with acute PJI is medically and surgically optimized. Although antibiotic duration is unknown, he noted a duration of 6 weeks has been recommended. Hamilton added patients should be treated with IV antibiotics plus oral rifampin for 1 week to 6 weeks after MRSA, and IV antibiotics with fluoroquinolone should be used in patients with a gram-negative rod.

“What about long-term oral antibiotic suppression?” Hamilton said. “There was one paper showing that if you used greater than 6 months of antibiotics, it improved survivorship for infection long term.” – by Casey Tingle

Reference:

Hamilton WG. DAIR to treat acute TJA infection. Presented at: Joint Arthroplasty Mountain Meeting; Feb. 10-13, 2019; Park City, Utah.

Disclosure: Hamilton reports he receives research support from Biomet and Inova Health Care Services, receives IP royalties and is a paid consultant for DePuy and Total Joint Orthopaedics, and is a paid presenter or speaker and receives research support from DePuy.