Outcomes and Risk Factors Associated With Failures of Debridement, Antibiotics, and Implant Retention in Patients With Acute Hematogenous Periprosthetic Joint Infection

Background: Acute hematogenous periprosthetic joint infections (PJI) accounts for 20% to 35% of all PJI cases. Treatment options include débridement, antibiotics, and implant retention (DAIR) or implant revision (single-stage/two-stage revision). Because the reported success rates of DAIR for acute PJIs as reported in the literature varies widely, this study aimed to investigate (1) the outcome of DAIR as revision surgery procedure and (2) the potential risk factors for treatment failure of DAIR in patients with acute hematogenous PJI.

Methods: We reviewed 106 consecutive cases of total joint arthroplasty patients who underwent DAIR for the diagnosis of acute hematogenous PJI. Outcomes of the cohort including infection free survival was investigated. Mean follow-up was 4.9 years. Demographics, case data, comorbidities, and extremity score were analyzed by univariate and multivariate regressions to identify risk factors for failure of DAIR.

Results: The failure rate of patients who underwent DAIR was 23.6% (25 of 106 patients). Univariate regression demonstrated that diabetes mellitus (P = 0.01) and polymicrobial infections (P < 0.01) are associated with failure of DAIR. Multivariate regression confirmed diabetes mellitus and polymicrobial infections as independent risk factors for failure of DAIR.

Discussion: Debridement, antibiotics, and implant retention may be a viable treatment option with moderate failure rates at the midterm follow-up in cases of acute hematogenous PJI. The study also identified diabetes mellitus and polymicrobial infections as independent risk factors for failure of DAIR. The findings of this study provide clinically useful information for surgeons in treatment of patients with acute hematogenous PJI.