Clinical efficacy of debridement, antibiotics, and implant retention (DAIR) combined with assembled components replacement in the treatment of acute prosthetic joint infection (PJI) after initial total hip arthroplasty

Abstract

Abstract Objective: To evaluate the efficacy of debridement, antibiotics, and implant retention (DAIR) combined with the assembled components replacement in the treatment of acute prosthetic joint infection (PJI). Methods: Twenty-two patients with acute PJI after undergoing initial total hip arthroplasty at the Department of Orthopedics between Jul 2018 and Feb 2022 were enrolled, and treated using DAIR combined with the replacement of assembled components. Infections were assessed based on measurement of white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels at the latest follow-up and before surgery. The performance of hip joint function was evaluated using Harris hip score (HHS), pain relief with visual analog scale (VAS) score, and pre/postoperative conditions analyzed using paired sample t-test. Results: Twenty-one patients were included in the follow-up analysis. Among them, 20 patients who received treatment with this method achieved successful cure of PJI. The levels of WBC, ESR, and CRP were lower in the last follow-up than those before surgery (WBC: 5.02 ± 0.85 vs. 10.60 ± 1.02, P < 0.05; ESR: 19.10 ± 9.94 vs. 64.90 ± 18.79, P < 0.05; CRP: 5.71 ± 1.65 vs. 55.52 ± 17.80, P < 0.05). HHS scores were higher in the last follow-up relative to before surgery (77.67 ± 7.67 vs. 41.35 ± 7.70, P < 0.05) and VAS scores were lower in the last follow-up than those before surgery (1.57 ± 0.68 vs. 5.86 ± 1.06, P < 0.05). Conclusions: DAIR combined with the replacement of assembled components can effectively control acute PJI.