Accuracy of Predictive Algorithms in Total Hip and Knee Arthroplasty Acute Periprosthetic Joint Infections Treated With Debridement, Antibiotics, and Implant Retention (DAIR)

Abstract Background Debridement, antibiotics, and implant retention (DAIR) failure remains high for total hip and knee arthroplasty periprosthetic joint infection (PJI). We sought to determine the predictive value of the CRIME80 and KLIC for failure of DAIR in acute hematogenous (AH) and acute postoperative (AP) PJIs, respectively. Methods We identified 134 patients that underwent DAIR for AH PJI with Results For the AP cohort, AUCs were below 0.66 for KLIC, CCI, ECI and McPherson Host Grade (MHG). For the AH cohort, 90-day AUCs were 0.70 for CRIME80, and below 0.66 for CCI, ECI, and MHG. In multivariate analysis controlling for age, sex, and BMI, the CRIME80 AUC improved to 0.77 at 90 days. Discussion To the authors’ knowledge, this study represents the first external validation of the KLIC and CRIME80 for predicting DAIR failure in a North American population. The results indicate that alternative methods for predicting DAIR failure at 90 days and 2 years for acute PJI are needed. Level of Evidence Prognostic III