VALIDATION OF THE EBJIS RECOMMENDATIONS FOR DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION (DAIR) AS A CURATIVE PROCEDURE IN THE HIP AND KNEE

Aim To investigate the validity of the recommendations from the 2025 EBJIS position paper 1 on DAIR and the relationship to clinical outcome. Method Patients undergoing DAIR for EBJIS criteria confirmed PJI of the hip or knee were classified using the EBJIS recommendations into ‘good indications for DAIR’, ‘higher risk’ or ‘DAIR contraindicated’. The quality of the surgery performed was also determined as ‘Full DAIR’, including good debridement and exchange of mobile parts or ‘Suboptimal’, without exchange or simple washout. The primary outcome was clinical failure, defined as reoperation for infection, continued antibiotic suppression, amputation, or death from PJI, after index surgery. Results 305 eligible patients (132 hips, 173 knees) were included from six UK centres, with a mean follow-up of 47.4 months (minimum 8 months). 88 had good indications, 72 had higher risk factors and 145 contraindications to DAIR. Full DAIR was performed in 195 cases (63.9%). Overall clinical failure rate was 45.9%. With all surgery, good indication patients had a significantly better outcome compared to higher risk or contraindicated cases (30.7% failure vs 33.3% and 61.4%; p=0.013). When a full DAIR was performed, patients with good indications, including with higher risks, had half the failure rate of those with contraindications (26/96, 27.1% vs 89/145, 56.6%; p<0.0001). The ideal situation (full DAIR in good indication patients) had a failure rate of 23.4% compared to 71.7% in contraindicated patients with suboptimal surgery (p<0.003). Suboptimal surgery increased the failure rate in all groups. Conclusions This large study confirms that the EBJIS recommendations for DAIR are valid and accurately predict the clinical outcome after surgery. Failure to perform a full DAIR was common (36.1%). Surgeons often chose DAIR in patients with definite contraindications (47.5%). Outcome from DAIR surgery could be greatly improved with implementation of the EBJIS recommendations.