Study finds, Extent in Chronicity of Symptoms in Irrigation
Periprosthetic joint infection (PJI) remains a rare, yet devastating complication of total joint arthroplasty (TJA). Chronic infection is generally considered a contraindication to debridement antibiotics and implant retention (DAIR).

A retrospective review of all DAIR cases was performed. Chronicity of PJI was categorized as Acute Post-Operative, Chronic or Acute Hematogenous. Failure after DAIR, defined as re-revision for infection recurrence with the same organism, was evaluated between the three chronicity groups at 90-days as well as at a minimum 2-year follow-up.

--Overall, 248 patients undergoing DAIR for THA or TKA PJI were included.

--Categorization of PJI was acute (acute post-operative) in 59 cases (24%), chronic in 54 (22%) and acute hematogenous in 135 (54%). DAIR survivorship was 47% (range 0.3-10 years).

--Overall, there were 118 treatment failures after DAIR with a minimum of 2-years follow-up. There was no difference in failure rate between total hip or total knee arthroplasty patients.

--Patients infected with Staphylococcus conferred a higher risk of failure for all DAIR procedures regardless of chronicity category.

Finally, when considering treatment options, identification of microbial species prior to DAIR may be more clinically important than stratification by chronicity group.