Debridement, antibiotics and implant retention (DAIR) is successful in the management of acutely infected unicompartmental knee arthroplasty: a case series

Figures & data

Table 1. Periprosthetic Joint Infection. Details and Treatment.

Patients (n = 19)	UKA side	Time from Primary UKA to DAIR (days)	CRP (mg/L)	Organism(s)	Follow-up (months)	Antibiotic(s) administered
1	M	16	52.5	Staphylococcus aureus	53	Rifampicin, Cefuroxime, Cotrimoxazole.
2	M	15	73.5	Staphylococcus epidermidis multi-resistant	52.5	Cefuroxime, Rifampicin, Ciprofloxacin.
3	M	8	65.5	Staphylococcus epidermidis multi-resistant	51	NA
4	L	14	NA	Enterobacter cloacae	49.5	Cefuroxime, Ciprofloxacin, Rifampicin.
5	M	12	87	Staphylococcus aureus	47	Rifampicin, Cefuroxime, Cotrimoxazole.
6	M	12	243	Streptococcus mitis	46	Rifampicin, Ciprofloxacin, Clindamycin.
7	L	50	154	Staphylococcus epidermidis	43	Rifampicin, Vancomycin, Flucloxacillin.
8	L	19	2.5	Streptococcus mitis, Streptococcus oralis	34.5	Cefuroxime, Rifampicin, Ciprofloxacin, Clindamycin.
9	M	12	95	Staphylococcus aureus	33.5	Ciprofloxacin, Rifampicin.
10	M	16	2.5	Staphylococcus aureus, staphylococcus epidermidis	28	Cefuroxime, Cotrimoxazole.
11	M	55	89	Staphylococcus epidermidis	27.5	Ciprofloxacin, Rifampicin.
12	M	33	119	Staphylococcus epidermidis, Staphylococcus coagulase negative, Corynebacterium.	NA	Cefuroxime, Rifampicin, Ciprofloxacin.
13	L	22	25	Staphylococcus aureus	24	Cefuroxime, Rifampicin, Amoxicillin/Clavulanic Acid.
14	M	16	171	Staphylococcus capitis, Staphylococcus epidermidis	22.5	Rifampicin, Cefuroxime, Ciprofloxacin.
15	M	11	75.9	Staphylococcus epidermidis	18	Rifampicin, Vancomycin, Cotrimoxazole.
16	M	22	18.5	Acinetobacter baumannii complex	16	Vancomycin, Rifampicin, Ampicillin/Sulbactam, Cotrimoxazole.
17	M	37	111	Staphylococcus epidermidis	14	Rifampicin, Flucloxacillin.
18	M	34	58	Staphylococcus aureus	13	Rifampicin, Vancomycin, Cotrimoxazole.
19	L	15	233	Staphylococcus aureus, Enterococcus faecalis	11.5	Vancomycin, Rifampicin, Amoxicillin/Clavulanic Acid.

CRP: C-Reactive Protein; DAIR: Debridement, Antibiotics and Implant Retention; L: Lateral; M: Medial; NA: Not Available/Applicable; UKA: Uni-compartmental Knee Arthroplasty.

Figure 1. Summary flowchart according to STROBE recommendations illustrating the patients analysed.

Figure 2. Kaplan–Meier Graph demonstrating survivorship free from re-infection following a single DAIR procedure in acute UKA infections. Each Dash

represents the point of patient discharge from follow-up with the advice to return to the clinic should symptoms recur.

Table 2. Complications after the first DAIR: Details and Treatment.

Patients (n = 4)	UKA side	Time from Primary UKA to 1st DAIR (days)	Time from 1st DAIR to 2nd DAIR procedure (days)	Details of 3rd operation	Organism(s)	Follow-up (months)
1	L	15	18	NA	Enterobacter cloacae	49.5
2	M	17	26	NA	Staphylococcus aureus, staphylococcus epidermidis	28
3	M	33	Planned for arthroscopy for an unrelated meniscal lesion.	NA	Staphylococcus epidermidis, Staphylococcus coagulase negative, Corynebacterium.	NA
4	L	22	17	260 days later successful TKA was performed for osteoarthritis progression-free from infection postoperatively.	Staphylococcus aureus	24

DAIR: Debridement Antibiotics and Implant Retention; L: Lateral; M: Medial; NA: Not Available/applicable; UKA: Uni-compartmental Knee Arthroplasty.

Table 3. Demonstrating the statistical features of all the patients who underwent primary DAIR procedures (n = 19).

	Mean	Standard deviation
Age (years)	71	8.03
Time to first DAIR (days)	22.05	13.1
Follow-up (months)	32.5	14.57
C-reactive protein levels (milligrams per Litre)	93	68.2

DAIR: Debridement Antibiotics and Implant Retention.

Table 4. Demonstrating the statistical features of patients who underwent a second DAIR procedure (n = 3).

	Mean	Standard deviation
Age (years)	66.3	11.12
Time to first DAIR (days)	18	2.83
Time to second DAIR (days)	20.3	4.03
Follow-up (months)	24.8	2.3
C-reactive protein levels (milligrams per Litre)	66.2	74.7

DAIR: Debridement, Antibiotics and Implant Retention.

Table 5. Demonstrating the statistical features of all the patients who were successfully treated with a single DAIR procedure (n = 16).

	Mean	Standard deviation
Age (years)	71.8	7.0
Time to DAIR (days)	22.8	14
Follow-up (months)	34	15.5
C-reactive protein levels (milligrams per Litre)	98.5	65.6

DAIR: Debridement, Antibiotics and Implant Retention.

Table 6. Summarising currently published results in addition to this study's.

Author(s) and year of publication	Study type	Number of cases	Acute or chronic infections	Number of DAIR procedures performed	Percentage success
Labruyère et al. [15]	Retrospective	9	mixed	5	44%
Hernandez et al. [14]	Retrospective	15	mixed	11	61%
Chalmers et al. [16]	Retrospective	21	mixed	16	64%
Brivio et al. (current results)	Retrospective	19	acute	19	84%

DAIR: Debridement, Antibiotics and Implant Retention.

Labruyère C, Zeller V, Lhotellier L, et al. Chronic infection of unicompartmental knee arthroplasty: one-stage conversion to total knee arthroplasty. Orthop Traumatol Surg Res. 2015;101(5):553–557.

 PubMed Web of Science ®Google Scholar

Hernandez NM, Petis SM, Hanssen AD, et al. Infection after unicompartmental knee arthroplasty: a high risk of subsequent complications. Clin Orthop Relat Res. 2019;477(1):70–77.

 PubMed Web of Science ®Google Scholar

Chalmers BP, Kapadia M, Chiu Y, et al. Treatment and outcome of periprosthetic joint infection in unicompartmental knee arthroplasty. J Arthroplasty. 2020;35(7):1917–1923.

 PubMed Web of Science ®Google Scholar

Data availability statement

The anonymised datasets generated in this study are available from the corresponding author (NM) on reasonable request.