Research Summary

Five-Year Outcomes of DAIR Comparable for Early, Delayed Prosthetic Joint Infection Treatment

Miranda Manier, BA

Key Highlights

  • The overall 5-year success rate of Debridement, Antibiotics, and Implant Retention (DAIR) for acute prosthetic joint infection (PJI) was 62.2%.
  • Success rates did not differ significantly between procedures performed within four weeks (64.4%) and those performed between five and 12 weeks (55.6%) post-arthroplasty.
  • Including deceased patients without infection, adjusted success rates increased to ~70% in both groups.
  • Implant survival rates were similar by joint type (hip vs knee).

Debridement, Antibiotics, and Implant Retention (DAIR) is commonly recommended as the first-line treatment for acute prosthetic joint infection (PJI), but uncertainty remains regarding the optimal timing of the procedure. This large retrospective analysis assessed the long-term outcomes of DAIR performed within different time frames after arthroplasty. Investigators found that 5-year success rates were similar regardless of whether DAIR was performed within 4 weeks or between 5 and 12 weeks following the index surgery, though overall success declined over time.

Acute PJI represents one of the most serious complications after joint arthroplasty, with an incidence of 1–2% in primary surgeries and up to 10% in revisions. DAIR is favored for its lower surgical burden, preservation of bone stock, and improved recovery compared with full revision surgery. However, the Infectious Diseases Society of America currently recommends DAIR only within the first month after surgery, despite limited evidence on long-term outcomes. Previous studies have largely been restricted to 1 year of follow-up, leaving unanswered questions about the durability of DAIR beyond the early postoperative period. This study was designed to fill that gap by examining 5-year success rates across early and later intervention windows.

Researchers reviewed medical records for 291 patients with acute PJI occurring within 3 months of primary or revision hip or knee arthroplasty between 1999 and 2018. Patients were divided into two groups: Group A underwent DAIR within 4 weeks of the index arthroplasty (n=219), while Group B underwent DAIR between 5 and 12 weeks (n=72). Success was defined as implant retention without signs of infection and without suppressive antibiotic therapy in surviving patients at five years. Mortality, implant survival, and microbiological data were also analyzed.

The overall 5-year success rate was 62.2% across the cohort. In Group A, success reached 64.4%, while Group B achieved 55.6%, a difference that was not statistically significant. When deceased patients without signs of infection were included as successful cases, success rates rose to 69.9% in Group A and 69.4% in Group B. Implant survival was 73% in Group A and 71% in Group B, with similar outcomes for hip and knee arthroplasties. Over time, outcomes worsened, with success rates declining from 75.6% to 62.2% in the last 3 years of follow-up.

The authors noted limitations including the retrospective design, which limits control of confounders and introduces potential bias, as well as the absence of a control group and the impact of evolving clinical protocols during the nearly 20-year study period.

“Our data suggest no significant difference in outcomes between patients undergoing DAIR within 4 weeks and those treated between weeks five and 12,” Perdomo-Lizarraga and colleagues concluded. “However, it is noticeable that the overall success rate decreased from 75.6 to 62.2% in the last 3 years of follow-up.”

Reference
Perdomo-Lizarraga JC, Combalia A, et al. Long-term implant survival after debridement, antibiotics and implant Retention (DAIR) for acute prosthetic joint infections: is it a viable option beyond four weeks after index arthroplasty? Int Orthop. 2025;49(3):573-580. doi:10.1007/s00264-025-06422-6