Contemporary outcomes of debridement, antibiotics and implant retention (DAIR) in hip arthroplasty

Abstract

A debridement, antibiotic-treatment and implant-retention (DAIR) is a valuable surgical option in the treatment of hip periprosthetic joint infection (PJI). Although the indications for DAIR remain controversial, it should be considered in all hip PJI cases with a soundly fixed prosthesis, despite chronicity and type of implant. DAIR is associated with significant reduced cost and better patient reported outcomes compared to 2-stage revision. Variable success, defined as eradication of infection, has been reported following DAIR (14% to 100%) which is partly due to heterogeneity of the cohorts reported, the length of follow-up and the various definitions of success used. The success following DAIR has continuously improved since 2004, with a pooled mean chance of success of 72.2%. A number of variables have been associated with chances of success that need to be considered, when surgeons decide to proceed with a DAIR. Those can be broadly divided into patient-, PJI-, surgical- and antibiotic-related factors; all of which are covered in this review. It is our opinion that a DAIR can achieve PJI eradication in the majority of patients in the hands of experienced surgeons in specialised centres with a multi-disciplinary team approach. Exchange of modular components and thorough debridement are paramount.