Debridement, Antibiotics, and Implant Retention (DAIR) Protocol for the Management of Early Periprosthetic Joint Infections: An Eight-Year Single-Centre Experience

Background: This study aims to assess how patient comorbidities and risk factors influence treatment outcomes of periprosthetic joint infection (PJI). The role of timing for DAIR intervention, administration of antibiotics, and the microbiological profile in relation to infection recurrence were investigated. Methods: This retrospective study included 58 patients, 26 after total hip arthroplasty (THA) and 32 after total knee arthroplasty (TKA), who underwent surgery for early PJI managed with the complete DAIR protocol at a single academic orthopedic center (Professor Adam Gruca Orthopedic and Trauma Teaching Hospital) between January 2014 and January 2021. A minimum follow-up period after DAIR was five years. Results: In the overall cohort, therapeutic success was achieved in 41 of 58 patients (71%). Treatment of early PJI after THA was successful in 21 of 26 patients (81%), while after TKA, 20 of 32 patients (63%) achieved a favorable outcome. An increase in the number of comorbidities associated with infection risk was correlated with a lower likelihood of successful treatment using the DAIR protocol. Our analysis also demonstrated that the timing from total joint arthroplasty (TJA) to surgical intervention, the administration of antimicrobial therapy, and positive culture results influenced the success rate. Conclusions: The effectiveness of the DAIR protocol in managing early PJI is influenced by multiple factors. This study suggests that crucial determinants include prompt and accurate diagnosis, identification of patient-specific risk factors, the causative pathogen and its antibiotic administration, as well as the timing of intervention.