Debridement, antibiotics and implant retention is a viable treatment option for early periprosthetic joint infection presenting more than four weeks after index arthroplasty

BACKGROUND: Success of debridement, antibiotics and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to time after index arthroplasty. METHODS: We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements and a follow-up <1 year were excluded. Treatment failure was defined as 1) any further surgical procedure related to infection 2) PJI-related death, 3) long-term suppressive antibiotics. RESULTS: 769 patients were included. Treatment failure occurred in 294 patients (38%) and was similar between time-intervals from index arthroplasty to DAIR: week 1-2: 42% (95/226); week 3-4: 38% (143/378); week 5-6: 29% (29/100), week 7-12: 42% (27/65). Exchange of modular components was performed to a lesser extent in the early compared with the late post-surgical course (41% vs 63%, p<0.001). The causative microorganisms, comorbidities and duration of symptoms were comparable between time-intervals. CONCLUSIONS: DAIR is a viable option in patients with early PJI presenting more than four weeks after index surgery as long as DAIR is performed at least within one week after the onset of symptoms and modular components can be exchanged.