Debridement, antibiotics and implant retention (DAIR) is successful in the management of acutely infected unicompartmental knee arthroplasty: a case series

Brivio, Angela; Al-Jabri, Talal; Martin, Jurgen; Barrett, David; Maffulli, Nicola

Abstract

Background
Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. This article presents the results of the largest multicentre clinical study of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR).

Materials and Methods
In this retrospective case series, patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection.

Results
A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with overall survivorship free from all-cause reoperation of 78.95%.

The most common bacteria were Coagulase-negative Staphylococci, Staphylococcus aureus and Group B Streptococci. Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery.

Conclusions
In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.

Key messages
Debridement, Antibiotics and Implant Retention (DAIR) is a successful and minimally invasive surgical option for the management of periprosthetic joint infections (PJIs) after UKA.

The surface area available for bacteria to colonise is much smaller in UKAs compared to total knee arthroplasties (TKAs), and this may account for the higher success rates of the DAIR procedure in infected UKAs versus infected TKAs.

A second DAIR procedure can be considered in the management of the early recurrence of PJIs with a well-fixed UKA.

Citation

Brivio, A., Al-Jabri, T., Martin, J., Barrett, D., & Maffulli, N. (2023). Debridement, antibiotics and implant retention (DAIR) is successful in the management of acutely infected unicompartmental knee arthroplasty: a case series. Annals of Medicine, 55(1), 680-688. https://doi.org/10.1080/07853890.2023.2179105

• Journal Article Type: Article
• Acceptance Date: Feb 6, 2023
• Online Publication Date: Feb 22, 2023
• Publication Date: Dec 12, 2023
• Deposit Date: Jan 29, 2024
• Journal: Annals of Medicine
• Print ISSN: 0785-3890
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: 1
• Pages: 680-688
• DOI: https://doi.org/10.1080/07853890.2023.2179105
• Keywords: General Medicine; Unicompartmental knee arthroplasty; failure; infection; dair; revision; periprosthetic joint infection
• Publisher URL: https://www.tandfonline.com/doi/full/10.1080/07853890.2023.2179105