Negative pressure wound therapy with intermittent irrigation prior to debridement, antibiotics and implant retention in delayed periprosthetic hip infections

Background: Infection control rate of debridement, antibiotics, and implant retention (DAIR) remains controversial. We aim to identify the influence of preoperative negative pressure wound therapy (NPWT) with intermittent pulsatile irrigation (IPI) on the efficacy of DAIR in delayed periprosthetic joint infection (PJI) hip cases. Methods: 112 patients with delayed hip PJI were randomized into two groups. Group A included 53 cases treated with DAIR only whereas group B included 59 cases treated with NPWT and IPI followed by DAIR. Surgical invasiveness parameters, postoperative drainage, inflammation markers, and reinfection rate were evaluated in two groups. Results: In group B, serologic and clinical inflammation markers decreased significantly than in group A, and major systemic or local adverse events were not observed during preoperative NPWT-based therapy. The duration of debridement and surgical invasiveness indices such as hemoglobin decrease were significantly lower in group B. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly lower in group B until 3 weeks after DAIR. In group B, the duration of antibiotics administration was considerably shorter than in group A. In groups A and B, reinfection rates were 35.8% and 1.7% at the final follow-up. Conclusions: Preoperative and postoperative NPWT could maximize DAIR's indication and success rate in delayed PJI cases.