Debridement, Antibiotics and Implant Retention in the Management of Periprosthetic Joint Infection: One-Year Outcomes, Epidemiology and Predictors of Failure

Background: Debridement, antibiotics, and implant retention (DAIR) is the treatment of choice for early and acute hematogenous periprosthetic joint infections (PJIs), but its success rates vary widely. The primary outcome of this study was to assess 1-year implant survival and treatment failure among DAIR patients. The secondary aims were to identify the causative pathogens and potential predictors of failure. Methods: Patients treated with DAIR for PJI in a single center between 2017 and 2025 were included. Implant survival was evaluated using Kaplan–Meier analysis, and univariate analysis was performed to explore potential associations between baseline variables and treatment failure. Results: 57 patients (58 hips/knees) were included. The mean age at surgery was 67.5 ± 11.5 years, and most procedures involved the hip (93.1%, n = 54). During follow-up, 7 patients (12.06%) experienced treatment failure. Kaplan–Meier analysis demonstrated a 1-year implant survival of 87.9%, with most failures occurring in the early postoperative months. The microbiological profile was dominated by Staphylococci (51.7%, n = 14) and polymicrobial (24.1%, n = 14) species, while Gram-negative bacteria and Enterococci were less frequently identified. Culture-negative infections were observed in 17.2% of cases (n = 10). Univariate analysis identified preoperative glucose levels and BMI as significantly different between groups, although these findings should be interpreted with caution. Conclusions: DAIR achieved favorable short-term outcomes in this cohort. Failures occurred mainly early after treatment, and the microbiological spectrum was consistent with the typical epidemiology of PJI. BMI and perioperative glucose levels may represent potentially modifiable factors associated with treatment failure.