Risk factors for failure following debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection after primary total hip arthroplasty

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Introduction: In the event of early or haematogenous periprosthetic joint infection (PJI), the preferred treatment is debridement, antibiotics, and implant retention (DAIR), with reported cure rates ranging from 60% to 80%. Nevertheless, the performance of this surgical strategy and the factors associated with poorer outcomes remain unknown in the Brazilian population. This study aims to evaluate the effectiveness of DAIR in early PJI following total hip arthroplasty (THA) and identify factors linked to unfavourable clinical outcomes. Methods: This is a retrospective cohort study of patients who underwent primary THA between January 2011 and December 2017, developed early PJI, and were treated with DAIR with a minimum follow-up of 1 year. An unfavourable outcome was defined as infection persistence, recrudescence, recurrence, or the need for revision surgery. Results: A total of 83 hips were included in the study, with a DAIR success rate of 72.3%. Staphylococcus aureus was the most frequently identified pathogen (59.7%), and no pathogen-related factors were associated with outcomes. Patient-related independent risk factors for unfavourable outcome included pre-DAIR haemoglobin ⩽ 10 g/dL (OR [95% CI] = 6.26, 1.63–24.08; p = 0.008) while a lower Charlson Comorbidity Index (CCI), a validated score that quantifies patient comorbidity burden, ⩽1 (OR [95% CI] = 0.04, 0.00–0.32; p = 0.003) and primary osteoarthritis (OR [95% CI] = 0.23, 0.06–0.95; p = 0.042) were protective. A procedure-related factor associated with failure was primary and THA surgical time ⩾180 minutes (OR [95% CI] = 10.15, 2.54–40.56; p = 0.001). Conclusions: In this population, prognostic factors associated with DAIR outcomes were related to patient characteristics and features of the index procedure rather than to antibiotic therapy or DAIR itself. These findings may help refine patient selection for DAIR and highlight potentially modifiable factors – such as preoperative anaemia, that could reduce the risk of treatment failure following THA.

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