The Fate of the DAIR, Outcomes After One Year: a large database study.

Abstract

Introduction: Debridement with antibiotics and implant retention (DAIR) is commonly utilized for prosthetic joint infection (PJI) for total knee arthroplasty (TKA); particularly in cases of acute PJI 1. Reported success rates of DAIR have been highly variable, but the overall success rate of DAIR cohort studies is ~70-80% 2. 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. Methods 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 1/1/2017 to 12/31/2021. 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 3. Results We identified 1018 patients who underwent a DAIR procedure for PJI. Of these patients, 195 (19.2%) underwent reoperation within one year and an additional 178 (17.5%) were prescribed suppressive antibiotics. For 780 patients with a minimum of two years of follow up, 164 (21%) underwent reoperation and an additional 179 (22.9%) were prescribed suppressive antibiotics. Patients with obesity and patients under age 60 had significantly higher rates of having reoperation or suppressive antibiotics at one year following DAIR. Conclusion DAIR is a viable option in the treatment of PJI with an approximately 19% rate of reoperation at two years. Our findings are consistent with that of previously published literature.