While PJI may be considered a surgical urgency, DAIR can be performed on a planned list if it allows for appropriate staffing and implants for the procedure. We hope that with a well-defined protocol as outlined we can gain a better understanding of the efficacy of DAIR procedure with more homogeneity to the procedure to better define when they are most successful while improving patient outcomes and reducing cost.ĭAIR Debridement, antibiotics, and implant retention Knee arthroplasty Periprosthetic joint infection.Ĭopyright © 2020 Elsevier B.V. This procedure should not be viewed as a simple washout. With appropriate indications and good surgical technique as described we believe DAIR is an excellent option in the treatment of periprosthetic joint infection. Implant longevity in the setting of a successful DAIR is equivalent to those of a primary arthroplasty. With the above methods we have demonstrated improved patient outcomes when compared to one- or two-stage arthroplasty with lower patient morbidity. Labs were significant for CRP of 212, ESR 105, and a WBC count of 11K. In the setting of a previously well-functioning, well-fixed arthroplasty with an acceptable soft tissue envelope and a treatable organism we report our methods for proceeding with a DAIR procedure, both unicompartmental and total knee. The patient has a history of rheumatoid arthritis and recently underwent a dental procedure a week ago. Given the heterogeneity of what is defined as a DAIR the literature is highly variable in terms of its efficacy from the perspective of infection eradication. Debridement, antibiotics, and implant retention (DAIR) is an attractive option as it has demonstrated better patient outcomes, comparable implant longevity to primary arthroplasty, and significantly reduced cost when successful. Once the sinus tract forms, the success rate of DAIR is reduced greatly. ![]() Qasim et al showed that the emergence of a sinus tract was a high-risk factor for a failed DAIR procedure. We dened failure of a DAIR procedure as a complete re-revision within 1 year after the DAIR procedure. DAIR is only suitable for those PJI patients with good conditions of bone and soft tissue in whom no sinus tract exists between the joint prosthesis and the skin. Group A underwent a DAIR procedure within 4 weeks, Group B between 4 and 12 weeks after the index procedure. While two-stage revision arthroplasty is viewed as the gold standard for the treatment of knee periprosthetic joint infection (PJI) in terms of infection eradication, it is associated with significant cost along with patient morbidity and mortality. We divided both hip and knee DAIR procedures into two groups according to time between index surgery and DAIR procedure.
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