Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty - a retrospective study.

Abstract

Purpose: Debridement, antibiotics, and implant retention (DAIR) is an established treatment modality in periprosthetic joint infections (PJIs), but success rates vary. This study compared the success of DAIR for PJIs after a total hip arthroplasty (THA), with or without local antibiotic delivery with CaSO ${}_4$ as the carrier material. Methods: A retrospective review of DAIR for PJIs after THA performed between 2010 and 2018, including 41 patients is conducted. A total of 27 patients were treated by DAIR with local antibiotics with CaSO ${}_4$ as the carrier material, and 14 patients were treated by a standard DAIR. The endpoints were treatment failure, defined as the need for a reoperation, either a second DAIR or a prosthesis removal or exchange due to persistent or recurrent infection, the initiation of a long-term suppressive antibiotic treatment, or death related to infection. Results: Considering any reoperation as an outcome, 11 of 14 cases treated without AB-CaSO ${}_4$ (79 %) and 4 of the 27 cases treated with AB-CaSO ${}_4$ failed (15 %). Considering revision as an outcome, 9 out of 14 cases treated without AB-CaSO ${}_4$ (64 %) and 4 of the 27 cases treated with AB-CaSO ${}_4$ (15 %) failed. A Kaplan-Meier survival analysis showed that local antibiotic delivery with CaSO ${}_4$ as the carrier material led to a significantly longer infection-free survival, considering any surgical revision ( $p<0.0001$ ; hazard ratio 8.9 (95 % CI 2.8-28.2)) or revision with component exchange ( $p=0.0015$ ; hazard ratio 5.6 (95 % CI 1.7-18.2)) as the endpoint. Conclusion: The addition of local antibiotics with CaSO ${}_4$ as the carrier material to DAIR for PJIs after THA significantly increases success rates, such as infection-free survival, any reoperation, and revision with component exchange in particular.