Subspecialty-trained surgeons have greater success with infection eradication for TKA
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Debridement, antibiotics and implant retention was more successful when performed by a fellowship-trained adult joint reconstruction surgeon compared with a non-fellowship-trained surgeon, according to presented results.
“Advantages of [debridement, antibiotics and implant retention] DAIR are that it only requires a single surgical procedure, shorter operative times, shorter hospital stays, lower overall treatment costs and improved acute postoperative mobility. Success rates vary from 26% to 96% in total knee arthroplasty [periprosthetic joint infection] PJI,” Nicholas Tubin said in his presentation at the Musculoskeletal Infection Society Annual Meeting. “There is no current literature on whether fellowship training in adult joint reconstruction has an impact on DAIR success in TKA,” he added.
Tubin and colleague retrospectively analyzed data for 112 patients who underwent DAIR at a single institution for TKA between 1996 and 2019. According to Tubin, 68 cases were performed by fellowship-trained (FT) surgeons and 44 cases were performed by non-fellowship-trained surgeons (NFT). According to the abstract, treatment failure was defined as reoperation or need for chronic suppressive antibiotic therapy.
Overall, FT surgeons had a lower rate of treatment failure and lower rates of patient mortality during the totality of PJI care, Tubin said. Failure of treatment was reported in 57.3% (n = 39) of the FT cohort and in 77.3% (n = 34) of the NFT cohort. Similarly, mortality was 16.1% (n = 11) for patients treated in the FT cohort and 29.5% (n = 13) for patients treated in the in the NFT cohort.
“DAIR should not be considered a simple ‘washout’ procedure, as it offers a great surgical option for ‘getting it right the first time’ in appropriate patients,” Tubin said. “Future care models for PJI should consist of FT surgeons as part of multidisciplinary teams,” he concluded.
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Tubin N, et al. Paper 1036. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 5-6, 2022; Pittsburgh (hybrid meeting).
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