Dislocation After Debridement, Antibiotics, and Implant Retention for Periprosthetic Joint Infections of the Hip

• Published in: The Journal of arthroplasty Vol. 38; no. 2; pp. 361 - 366
• Main Authors: Humphrey, Tyler J., Salimy, Mehdi S., Melnic, Christopher M., Bedair, Hany S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2023
• Subjects: Anti-Bacterial Agents - therapeutic use; DAIR; Debridement; dislocation; Hip Dislocation - etiology; Hip Dislocation - surgery; Humans; instability; Joint Dislocations; periprosthetic joint infection; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Retrospective Studies; THA; Treatment Outcome; periprosthetic joint infection; dislocation; DAIR; THA; instability
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.08.029

Debridement, antibiotics, and implant retention (DAIR) is a common treatment option for hip periprosthetic joint infection (PJI). However, noninfectious outcomes of DAIR such as instability are not well reported. The purpose of this study was to evaluate risk factors for hip dislocation post-DAIR for PJI of both primary and revision total hip arthroplasty (THA).
A retrospective chart review identified all patients who underwent DAIR of a primary or revision THA over a 20-year period with a minimum 1-year follow-up. A total of 151 patients met inclusion criteria, 19.9% of whom had a post-DAIR dislocation. Demographic and intraoperative variables were obtained. Patients who had modular components exchanged during DAIR to those with increased offset, increased “jump distance”, or a more stable acetabular liner were defined as patients who had “components exchanged to increase stability.” Predictors of hip dislocation post-DAIR were inserted into a multivariate linear regression.
Post-DAIR dislocation rates were 16.3% in primary THAs and 25.4% in revision THAs. In patients who had “components exchanged to increase stability” during hip DAIR, there was at least an 11-fold reduction (1/odds ratio (OR), 0.09) in dislocation risk compared to patients who had no components altered during modular component exchange during hip DAIR (OR, 0.09; 95% confidence interval, 0.02-0.44; P < .001), while a 13-fold increased dislocation risk was seen in patients with a history of neuromuscular disease (OR, 13.45; 95% confidence interval, 1.73-104.09; P = .01).
During DAIR of hip PJI, surgeons should consider prophylactically exchanging components to increase stability even if components appear stable intraoperatively.