title: Outcome Following Debridement, Antibiotics, and Implant Retention in Hip Periprosthetic Joint Infection-An 18-Year Experience.
abstract: Debridement-antibiotics-and-implant-retention (DAIR) may be considered a suitable surgical option in periprosthetic joint infections (PJIs) with soundly fixed prostheses, despite chronicity. This study aims to define the long-term outcome following DAIR in hip PJI.
  
  
  
  We reviewed all hip DAIRs performed between 1997 and 2013 (n = 122) to define long-term outcome and identify factors influencing it. Data recorded included patient demographics, medical history, type of DAIR performed (+/- exchange of modular components), and organisms identified. Outcome measures included complications and/or mortality rate, implant survivorship, and functional outcome (Oxford Hip Score).
  
  
  
  Most DAIRs (67%) were of primary arthroplasties and 60% were performed within 6 weeks from the index arthroplasty. Infection eradication was achieved in 68% of the first DAIR procedure. In 32 cases, more than one DAIR was required. Infection eradication was achieved in 85% of the cases (104/122) with the (single or multiple) DAIR approach. The most common complication was PJI-persistence (15%), followed by dislocation (14%). Very good functional outcomes were obtained, especially in primary arthroplasties. All streptococcus infections were resolved with DAIR and had better outcome. Twenty-one hips have been revised (17%) to-date, 16 were for persistence of PJI. The 10-y implant survivorship was 77%. Early PJI and exchanging modular components at DAIR were independent factors for a 4-fold increased infection eradication and improved long-term implant survival.
  
  
  
  DAIR is, therefore, a valuable option in the treatment of hip PJI, especially in the early postoperative period (≤6 weeks), with good outcomes. However, DAIR is associated with increased morbidity; further surgery may be necessary and instability may occur. Where possible, exchange of modular implants should be undertaken.
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: George
authors.initials: G
authors.lastname: Grammatopoulos
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kendrick
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McNally
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Athanasou
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Atkins
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: McLardy-Smith
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Gundle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D003646:Debridement / Q000706:statistics & numerical data*; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D004204:Joint Dislocations; D008297:Male; D008875:Middle Aged; D060489:Prosthesis Retention; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: DAIR; hip; outcome; periprosthetic joint infection; revision