Presenter: High failure rates of irrigation, debridement alone do not support its use
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TAMPA, Fla. — Periprosthetic joint infection treated with debridement, antibiotics, irrigation and implant retention resulted in a three times higher failure rate than when these measures were used along with modular component exchange.
At the Orthopaedic Research Society Annual Meeting, Anirudh Buddhiraju, MBBS, presented findings of a retrospective study of 115 patients with acute periprosthetic joint infection (PJI). Of these patients, 36 had total hip arthroplasty and 79 had total knee arthroplasty. The mean follow-up was 2.8 years.
In a recorded presentation, he said the patients’ infected joints were treated with debridement, antibiotics and implant retention (DAIR) with or without a modular component exchange.
Among the findings was an overall 26% failure rate among patients with PJI. The failure rate for THA was 19.4% and the failure rate for TKA was 29.1%, Buddhiraju said, noting “PJI is a dreaded complication.”
However, the key take-home from the study was the 63.6% failure rate with DAIR alone, as well as a 22.2% failure rate with DAIR and the inclusion of modular component exchange.
“DAIR alone should not be recommended for the treatment of acute PJI, but must always be accompanied by modular component exchange, which may reduce the future prevalence of revision THA,” Buddhiraju said.
According to the abstract, patients in the groups who underwent DAIR vs. DAIR with modular component exchange were fairly equally matched.
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Stuart B. Goodman, MD, PhD, FRCSC, FACS, FBSE, FICORS
Modern joint arthroplasties include modular components, giving the surgeon more options to reconstruct the joint replacement according to the patient’s individual anatomy. However, when a total joint arthroplasty becomes acutely infected and the surgeon has performed a sound reconstruction, what are the next steps? Most surgeons would agree that during the DAIR procedure, retention of stable, well-positioned components should be undertaken. A recent report at the 2022 Orthopaedic Research Society Annual Meeting by Dr. Young-Min Kwon’s group at Harvard suggests that, in addition to the extensive arthrotomy and debridement of infected and devitalized tissue, all accessible modular parts should also be changed. This approach makes good sense, as it facilitates a more thorough debridement of the modular interfaces that may harbor bacteria.
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Klemt C, et al. Paper 186. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 4-8, 2022; Tampa, Fla.
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