LOWER RATES OF REOPERATION FOLLOWING SINGLE-STAGE OR PARTIAL EXCHANGE COMPARED TO DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION FOR ACUTE PERIPROSTHETIC JOINT INFECTION FOLLOWING TOTAL HIP ARTHROPLASTY

This study aims to (1) compare treatment outcome of debridement, antibiotics, and implant retention (DAIR) compared to single-stage revision arthroplasty (SSRA) for early postoperative (≤6 weeks from surgery) and acute hematogenous (<4 weeks of symptoms) total hip arthroplasty (THA) periprosthetic joint injection (PJI), and (2) identify factors associated with treatment outcome. A retrospective cohort study of patients who underwent revision surgery for PJI between 2004–2021 with a minimum 1-year follow-up. Treatment success was defined as treatment eradication as per Delphi-based International Multidisciplinary Consensus at a minimum of 1-year, with or without suppressive antibiotics. The effect of different factors on treatment outcome was determined. One hundred and two patients (mean age of 66.76 ± 13.5 years) served as the study population. Seventy-six patients (74.5%) underwent DAIR while 26 patients (25.5%) underwent a partial or complete SSRA. At a mean follow-up of 8.2 ± 5.7 years, significantly more patients initially treated with DAIR failed treatment (DAIR, 50 [65.8%]; SSRA, 10 [40%]; p=0.015). Bivariate regression analysis showed that performing a SSRA was associated with a higher likelihood of treatment success (OR 4.499, 95% CI 1.600 to 12.647, p = 0.004) while higher BMI was associated with treatment failure (OR 0.934, 95% CI 0.878 to 0.994, p = 0.032). To reduce the rate of recalcitrant infection after revision arthroplasty for early postoperative or acute hematogenous THA PJI, surgeons should attempt a single-stage revision whenever feasible. High-quality evidence validating the potential benefit of SSRA over DAIR is urgently needed to guide patients, physicians, and health policy experts.