Enhancing treatment outcomes for Acute Periprosthetic Hip Joint infection: optimizing debridement, antibiotics, and Implant Retention through vacuum sealing drainage in the deep tissue

Abstract

Background

Debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) is under debated since the reported success rate is inconsistent. This study aimed to explore the efficacy of vacuum sealing drainage (VSD) used as an adjunct to irrigation and debridement for acute PJI.

Methods

Patients undergoing debridement, irrigation with component retention, and application of vacuum seal drainage in the deep portion surrounding the infected sites from January 2014 to February 2021 were retrospectively reviewed. The definition of failure included the requirement of prosthesis removal; persistent infection-related symptoms; suppressive antibiotics therapy due to failure of controlling the infection; infection-related death.

Results

45 patients were included in this study with a mean follow-up of 45.62 ± 13.87 months. There were 28 males and 17 females with a mean age of 63.29 ± 17.74 months. The overall success rate was 86.67% with 6 failures. Multivariate analysis revealed a significant association between Charlson comorbidity index and treatment failure (OR = 2.226, 95% CI, 1.057–4.687, p = 0.035).

Conclusions

The incorporation of VSD in the deeper region enhances the outcomes of DAIR, achieving an 86.67% success rate in managing acute PJI. This approach offers a potentially safe and effective treatment, though patients with higher Charlson comorbidity index and elevated preoperative CRP levels face increased risks of failure.