Acute Hematogenous Infections after Total Knee Arthroplasty: Results of Debridement, Antibiotics, and Implant Retention

Abstract

The frequency of acute hematogenous infection (AHI) following total knee arthroplasty (TKA) is between 0.2% and0.5%. There is controversy over the results of patients treated for AHIs by surgical debridement, antibiotics, and implantretention (DAIR). This narrative review of the literature aims to establish of DAIR in late AHIs after TKA. The publishedsuccess rate (retention of the prosthesis) after DAIR is between 50% and 100%. The success rate is associatedwith a shorter duration of symptoms (5–14 days from the onset of symptoms). Factors associated with failure are anaccompanying infection and the diagnosis of rheumatoid arthritis before the TKA is performed. It is not recommendedto indicate a DAIR in patients with atrial fibrillation, chronic obstructive pulmonary disease, the presence of >15 cellsper high-powered field, preoperative C-reactive protein >500 mg/L or methicillin-resistant S. aureus. In such patients,a two-stage revision arthroplasty should be recommended. In conclusion, arthroscopic DAIR has a limited effect. It ismost efficacious in the very early stage of acute presentations of infected TKA. It can be useful in patients with extremefrailty as an adjunct to suppressive antibiotic therapy. If carried out, high volumes of fluid should be utilized. Theindications for an open DAIR are the following: duration of clinical signs and symptoms is less than 3 weeks; patientswith a well-fixed implant; no abscess or sinus tract; low-virulence bacteria; elderly patients with multiple comorbidities;and nonimmunocompromised patients. Open DAIR should not be advised in cases with chronic infection (>4 weekspostoperatively, insidious beginning of symptoms).Level of evidence: III