Knee prosthetic joint infection : Interest of early debridement, antibiotics, and implant retention strategy

##plugins.themes.academic_pro.article.sidebar##

Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.6003
Download
pdf
Vol. 103 No. 9 (2025): Tunis Med sept 2025

##plugins.themes.academic_pro.article.main##

Talel Znagui
Orthopedic surgery department, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Houssem Eddine Chahed
Orthopedic surgery department, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Skander Hamila
Orthopedic surgery department, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Youssef Mallat
Orthopedic surgery department, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Maamoun Dridi
Orthopedic surgery department, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Khalil Amri
Orthopedic surgery department, Military hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract

 


Introduction: Peri joint infections (PJI) are terrible complications that result in high morbidity and a significant financial impact on healthcare costs. Management of PJI requires a multidisciplinary approach. Debridement, antibiotics, and implant retention (DAIR) with or without modular components exchange is attractive as it prevents the unnecessary removal of implants.


Methods: It was a single-center, observational, descriptive, and retrospective study, carried over a period of 7 years. DAIR was defined as successful if not followed by a revision surgery. the recovery is considered by the absence of and biological signs of infection during the follow up period. The necessity of re-revision or removal of the prothesis represents a failure of the DAIR.


Results:  We included 15 patients. The mean age in our series was 69,8. The mean delay of infection onset was 24.8 days. Debridement and irrigation were used in all cases, while modular components were changed in 9 cases which represents 60% of cases. Intraoperative samples were positive in 11 patients which represents 73%. Staphylococcus aureus was the most implicated germ. The outcome was considered favourable in 11 patients which represents 73% of the cases. Patients who had modular components had higher success rates (78% vs 67%) without a significative difference. A delay higher than 3 weeks led to a higher percentage of unfavourable outcomes without a significative difference.


Conclusion: Multidisciplinary approach should be implemented to achieve favourable outcome. DAIR with modular components exchange is considered as an effective option for patients developing an early PJI.

Keywords:

Arthroplasty, Infection, Knee, Debridement, Antibacterial agents

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Longo UG, Ciuffreda M, Mannering N, D’Andrea V, Cimmino M, Denaro V. Patellar Resurfacing in Total Knee Arthroplasty: Systematic Review and Meta-Analysis. J Arthroplasty. 2018 Feb 1;33(2):620–32.
  2. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and Management of Infection After Total Knee Arthroplasty. JBJS. 2003 Jan;85(suppl_1):S75.
  3. Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J. Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection. Clin Orthop Relat Res. 2011 Nov;469(11):3043.
  4. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-Joint Infections. N Engl J Med. 2004 Oct 14;351(16):1645–54.
  5. Longo UG, De Salvatore S, Bandini B, Lalli A, Barillà B, Budhiparama NC, et al. Debridement, antibiotics, and implant retention (DAIR) for the early prosthetic joint infection of total knee and hip arthroplasties: a systematic review. J ISAKOS. 2023 Sep;S2059775423005588.
  6. Chalmers BP, Kapadia M, Chiu YF, Miller AO, Henry MW, Lyman S, et al. Accuracy of Predictive Algorithms in Total Hip and Knee Arthroplasty Acute Periprosthetic Joint Infections Treated With Debridement, Antibiotics, and Implant Retention (DAIR). J Arthroplasty. 2021 Jul 1;36(7):2558–66.
  7. Riesgo AM, Park BK, Herrero CP, Yu S, Schwarzkopf R, Iorio R. Vancomycin Povidone-Iodine Protocol Improves Survivorship of Periprosthetic Joint Infection Treated With Irrigation and Debridement. J Arthroplasty. 2018 Mar 1;33(3):847–50.
  8. Klement MR, Cunningham DJ, Wooster BM, Wellman SS, Bolognesi MP, Green CL, et al. Comparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection. JAAOS - J Am Acad Orthop Surg. 2019 May 1;27(9):e437.
  9. Manrique J, Komnos GA, Tan TL, Sedgh S, Shohat N, Parvizi J. Outcomes of Superficial and Deep Irrigation and Debridement in Total Hip and Knee Arthroplasty. J Arthroplasty. 2019 Jul 1;34(7):1452–7.
  10. Rudelli BA, Giglio PN, de Carvalho VC, Pécora JR, Gurgel HMC, Gobbi RG, et al. Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention. BMC Musculoskelet Disord. 2020 Aug 24;21(1):574.
  11. Tirumala V, Smith E, Box H, Kieboom J van den, Klemt C, Kwon YM. Outcome of Debridement, Antibiotics, and Implant Retention With Modular Component Exchange in Acute Culture-Negative Periprosthetic Joint Infections. J Arthroplasty. 2021 Mar 1;36(3):1087–93.
  12. Veerman K, Raessens J, Telgt D, Smulders K, Goosen JHM. Debridement, antibiotics, and implant retention after revision arthroplasty: antibiotic mismatch, timing, and repeated DAIR associated with poor outcome. Bone Jt J. 2022 Apr 1;104-B(4):464–71.
  13. Jämsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, Diabetes, and Preoperative Hyperglycemia as Predictors of Periprosthetic Joint Infection: A Single-Center Analysis of 7181 Primary Hip and Knee Replacements for Osteoarthritis. J Bone Jt Surg. 2012 Jul 18;94(14):e101.
  14. Chen W, Klemt C, Smith EJ, Tirumala V, Xiong L, Kwon YM. Outcomes and Risk Factors Associated With Failures of Debridement, Antibiotics, and Implant Retention in Patients With Acute Hematogenous Periprosthetic Joint Infection. J Am Acad Orthop Surg. 2021 Dec 1;29(23):1024–30.
  15. Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J. 2017 Jun;14(3):529–36.
  16. SOLARINO G, ABATE A, VICENTI G, SPINARELLI A, PIAZZOLLA A, MORETTI B. Reducing periprosthetic joint infection: what really counts? Joints. 2016 Jan 31;3(4):208–14.
  17. Pellegrini A, Meani E, Macchi V, Legnani C. One-stage revision surgery provides infection eradication and satisfying outcomes for infected knee arthroplasty in selected patients. Expert Rev Anti Infect Ther. 2021 Jul 3;19(7):945–8.
  18. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev. 2019 Jul;4(7):482–94.
  19. Argenson JN, Arndt M, Babis G, Battenberg A, Budhiparama N, Catani F, et al. Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019 Feb 1;34(2):S399–419.
  20. Kuiper JWP, Vos SJC, Saouti R, Vergroesen DA, Graat HCA, Debets-Ossenkopp YJ, et al. Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop. 2013 Aug;84(4):380–6.
  21. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999 May 21;284(5418):1318–22.
  22. Zimmerli W, Waldvogel FA, Vaudaux P, Nydegger UE. Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis. 1982 Oct;146(4):487–97.
  23. Høiby N, Bjarnsholt T, Givskov M, Molin S, Ciofu O. Antibiotic resistance of bacterial biofilms. Int J Antimicrob Agents. 2010 Apr;35(4):322–32.
  24. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013 Jan;56(1):e1–25.
  25. Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P, et al. One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother. 2009 Jun 1;63(6):1264–71.
  26. Löwik CAM, Jutte PC, Tornero E, Ploegmakers JJW, Knobben BAS, Vries AJ de, et al. Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score. J Arthroplasty. 2018 Aug 1;33(8):2582–7.
  27. Letouvet B, Arvieux C, Leroy H, Polard JL, Chapplain JM, Common H, et al. Predictors of failure for prosthetic joint infections treated with debridement. Médecine Mal Infect. 2016 Feb 1;46(1):39–43.
  28. Soriano A, García S, Bori G, Almela M, Gallart X, Macule F, et al. Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect. 2006 Sep 1;12(9):930–3.