Patient selection for DAIR
Success with DAIR is highly dependent on patient selection and surgical technique. DAIR may be appropriate to treat early postoperative infection or late acute infectionHaasper, 2014Osmon, 2013. Although DAIR has lower success rates for late acute infection, it is still reasonable to consider because of its advantages in reduced costs and morbidity and shorter hospital stay. DAIR is not recommended for patients with late chronic infection if the intent is curative because of low success ratesDavis, 2022. If cure is not achieved with DAIR, patients may require two-stage exchange arthroplasty.
It is recommended that DAIR only be considered if both of the following criteria are met:
- a stable, well-fixed prosthesis (without periprosthetic lytic areas identified by radiological investigation)
- good condition of the surrounding skin and soft tissue (without evidence of a sinus).
The following factors have been shown to lower the success rate of DAIR when compared to exchange arthroplasty and should be taken into account when considering DAIR as a definitive strategy:
- late acute infectionDavis, 2022
- polymicrobial infection
- infection with Staphylococcus aureusWouthuyzen-Bakker, 2020 Davis, 2022
- infection with an organism that is resistant to oral antibiotics suitable for treating arthroplasty device infections (ie antibiotics with good oral bioavailability)
- the presence of multiple comorbidities (including chronic kidney disease, liver cirrhosis, chronic obstructive pulmonary disease [COPD], rheumatoid arthritis, immunosuppressive therapy or active malignancy)Haasper, 2014Lora-Tamayo, 2013Wouthuyzen-Bakker, 2018.