Review of Recent Advances in Managing Periprosthetic Joint Infection After Total Knee Arthroplasty: DAIR Technique

Abstract: Periprosthetic joint infection (PJI) is a significant complication that can arise after joint arthroplasty. The Debridement, Antibiotics, and Implant Retention (DAIR) approach is gaining popularity as a treatment to preserve the joint, especially in cases of early or acute infections. This review compiles recent evidence to assess the effectiveness, prognostic factors, and limitations of the DAIR method in managing PJI. Success rates for DAIR vary widely, ranging from 41% to 92%. These rates are significantly influenced by several factors, including the timing of the infection, the microbial profile, patient characteristics, and the surgical techniques used. Success rates for DAIR are generally highest (over 70– 90%) when performed within 4– 6 weeks of symptom onset, along with the exchange of modular components, particularly for patients who present a lower risk. Staphylococcus aureus infections, when coupled with delayed presentation and comorbidities like advanced age and chronic kidney disease, are associated with higher rates of treatment failure. The use of rifampin, especially when combined with fluoroquinolones, improves patient outcomes. However, the optimal antibiotic regimens have yet to be clearly established. Emerging techniques like DAPRI and novel antiseptic irrigation solutions (eg, Bactisure ® ) show promise but need further clinical validation. While DAIR offers significant benefits, its variable success highlights the importance of careful patient selection and the urgent need for high-quality clinical research to establish standardized protocols and enhance long-term outcomes. Keywords: arthroplasty, replacement, knee, debridement, prosthesis-related infections, risk factors