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DAIR in a DGH following knee and hip replacements


Presenting Author - Joseph Ignatius
OBJECTIVE: DAIR :- Debridement, Antibiotics and Implant Retention is a recognised procedure in the management of Prosthetic Joint infection[PJI]. We present an experience of DAIR following hip and knee replacements in a District General Hospital [DGH]. METHODS: A retrospective review of 14 patients who underwent DAIR procedures between August 2012 and December 2015 was undertaken. The cohort included primary, complex primary and revision hip and knee replacements. All patients received multidisciplinary care with surgery performed by one of the two arthroplasty surgeons. RESULTS: 9 males and 5 females with age 62- 78 years [Mean 70.7] and BMI 22- 44.2 [Mean 33.8] with various comorbidities underwent DAIR. Surgical critieria required DAIR be performed within 3 weeks of the onset of symptoms of infection. The time from index surgery, however ranged from 15 days to 58 months. 12 out of 14 grew positive cultures including two growing Vancomicin resistant Enterococcus. Intravenous[IV] antibiotics were commenced after intraoperative samples and tailored following culture. IV antibiotics were continued in six patients after discharge using OPAT while 8 were discharged with oral antibiotics. Antibiotic schedule varied from six weeks to eight months.One patient died in the immediate postoperative period due to generalised sepsis. Another patient died of myocardial infarction 2 years after successful DAIR. 12 [85.7%] patients remain under followup. Mean followup is 20 months with no recurrence of infection or reoperation. CONCLUSIONS: With appropriate patient selection, DAIR is a safe and reproducible surgical option in PJI in hip and knee replacements avoiding the implications of a one or two stage Revision. Published data in contemporary literature is predominantly from specialised centres. Our small series provides a perspective of early to mid term results of DAIR from DGH. Interestingly each procedure is categorised as a failed implant on the National Joint Register.