Deijkers RL, van Elzakker EPM, Pijls BG. Debridement, Antibiotics, and Implant Retention with the Direct Anterior Approach for Acute Periprosthetic Joint Infection Following Primary THA.
JB JS Open Access 2020;
5:e0062. [PMID:
33123664 PMCID:
PMC7418914 DOI:
10.2106/jbjs.oa.19.00062]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background:
Periprosthetic joint infection (PJI) is a devastating complication following
total hip replacement. The direct anterior approach for total hip
replacement is becoming increasingly popular. However, little is known about
the success rate of treatment with debridement, antibiotics, and implant
retention (DAIR) using the direct anterior approach. The aim of this study
was to analyze the effectiveness of DAIR using this approach and identify
patient and surgical factors that influence the results.
Methods:
Seventy-four patients (75 hips) in whom DAIR had been performed were
identified from the records of the weekly multidisciplinary infection
meeting and the laboratory information management systems. In 4% (3 hips),
modular components were exchanged. To consider competing risks (death), we
used competing risk models.
Results:
The competing risk analysis showed a successful outcome after DAIR of 82% at
4 years of follow-up; this rate was 89% at 4 years follow-up when excluding
patients managed with gentamicin beads. The sensitivity analysis revealed
that obesity (body mass index [BMI] of ≥30 kg/m2), use of
gentamicin beads, and an erythrocyte sedimentation rate (ESR) of >40
mm/hr increased the risk of failure.
Conclusions:
DAIR using the direct anterior approach without the routine exchange of
modular components offers a success rate that is comparable with other
approaches for eradicating acute PJI following primary hip arthroplasty.
Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for
a complete description of levels of evidence.
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