The Fate of the DAIR, Outcomes after 1 Year: A Large Database Study

Abstract

Debridement with antibiotics and implant retention (DAIR) is commonly utilized for treatment of prosthetic joint infection (PJI) in total knee arthroplasty (TKA), particularly in cases of acute PJI. Reported success rates of DAIR have been highly variable, but the overall success rate of DAIR cohort studies is approximately 70 to 80%. However, no large database studies have investigated the success rate of DAIR. Therefore, we seek to provide a framework for large-database analysis of PJI interventions and their outcomes and to assess the success rate of DAIR. We queried the MarketScan Database for patients who underwent a DAIR (CPT 27310 and/or CPT 27486) procedure for indication of PJI (ICD-10 T84.53 OR T84.54) between January 1, 2017 and December 31, 2021. We identified reoperations (i.e., stage 1 revision, amputation, or arthrodesis) indicating failure of DAIR. Failure of DAIR treatment was defined by subsequent reoperation. We also identified prescriptions of suppression antibiotics more than 6 months after DAIR. We identified 1,018 patients who underwent a DAIR procedure for PJI. Of these patients, 195 (19.2%) underwent reoperation within 1 year and an additional 178 (17.5%) were prescribed suppressive antibiotics. For 780 patients with a minimum of 2 years of follow-up, 164 (21%) underwent reoperation and an additional 179 (22.9%) were prescribed suppressive antibiotics. Patients with obesity and patients younger than 60 years had significantly higher rates of having reoperation or suppressive antibiotics at 1 year following DAIR. DAIR is a viable option in the treatment of PJI, with an approximately 19% rate of reoperation at 2 years. Our findings are consistent with that of previously published literature.

Keywords

prosthetic joint infection - debridement with antibiotics - single-stage revision - two-stage revision

Ethical Approval

This submission has been reviewed and approved by the NEBH IRB, Assurance # FWA 00009165. During the review, the IRB specifically considered (1) the risks and anticipated benefits, if any, to subjects; (2) the selection of subjects; (3) the procedures for securing and documenting informed consent; (4) the safety of subjects; and (5) the privacy of subjects and confidentiality of the data.

Publication History

Received: 11 April 2024

Accepted: 10 December 2024

Accepted Manuscript online:
12 December 2024

Article published online:
15 January 2025

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