ArticleInternational orthopaedics2025
Clinical outcomes of an unplanned second debridement, antibiotics and implant retention (DAIR) procedure in acute postoperative prosthetic joint infections.
Article in International orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Twenty common errors in the prevention, diagnosis, and treatment of fracture-related infection (FRI).Journal of bone and joint infection · 2026Review
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8 authors.
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Abstract
introductionDebridement, antibiotics, and implant retention (DAIR) is a commonly employed strategy for managing acute postoperative prosthetic joint infections (PJI) while preserving the prosthesis. However, the clinical value of an unplanned second DAIR - performed due to inadequate infection control - remains controversial and is often considered a potential treatment failure. This study aimed to compare the two year clinical outcomes of patients undergoing a single DAIR versus those requiring an unplanned second DAIR for acute postoperative PJI of the hip or knee.
methodsWe retrospectively reviewed electronic medical records of patients treated with DAIR for acute postoperative PJI between January 1999 and December 2020. Patients were categorized into two groups: those managed with a single DAIR (DAIR-1 group) and those requiring an unplanned second DAIR within 12 weeks (DAIR-2 group). Treatment failure was defined as any of the following: further debridement beyond 12 weeks, revision surgery with prosthesis removal, initiation of long-term suppressive antibiotic therapy, or PJI-related mortality. Patients lost to follow-up before two years were excluded.
resultsA total of 318 patients were included, with 292 in the DAIR-1 group and 26 in the DAIR-2 group. Mean follow-up was 89.4 months. At two years, revision surgery was required in 19.2% (56/292) of DAIR-1 patients and 42.3% (11/26) of DAIR-2 patients (p = 0.005). Overall failure-free survival at two years was observed in 75.3% (220/292) of DAIR-1 patients compared to 46.2% (12/26) of those in the DAIR-2 group (p = 0.001).
conclusionUnplanned second DAIR procedures are associated with significantly lower success rates at two years. Nonetheless, given that nearly half of these patients remained free of failure, a second DAIR may still be a reasonable therapeutic option in selected cases, provided that the increased risk of a poorer prognosis is taken into account.
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