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DAIR (Debridement, Antibiotics, and Implant Retention) for the Treatment of Periprosthetic Joint Infection of Knee

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Infection in Knee Replacement

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Abstract

Prosthetic joint infection (PJI) is one of the most devastating complications following joint replacement. The primary goal of treatment is eradication of the infection. Maintenance of a pain-free, functional joint is the secondary goal, which is also important. The surgical options include irrigation, debridement, antibiotics, and implant retention with or without polyethylene exchange (DAIR), one-stage or two-stage revision, resection arthroplasty, arthrodesis, and amputation. When patients are contraindicated to undergo DAIR treatment, either one stage or multiple stages revision surgery is the preferred option. The fundamental aspects for a successful DAIR are related to tissue, stability of the prosthesis, and susceptibility of the organism. Resection arthroplasty (without reimplantation), arthrodesis, and amputation remain valid options for difficult to treat and chronic PJI, and these treatment options very rarely have a role in acute PJI cases. Non-surgical medical treatment such as antibiotic suppression therapy should be reserved for patients who are unfit or contraindicated for surgery.

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Authors and Affiliations

  1. Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Jakarta, Indonesia

    Nicolaas C. Budhiparama, Asep Santoso, Hendy Hidayat & Nadia N. Ifran

  2. Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia

    Nicolaas C. Budhiparama

  3. Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

    Nicolaas C. Budhiparama

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  1. Nicolaas C. Budhiparama
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  2. Asep Santoso
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  1. Università Campus Bio-Medico di Roma, Rome, Italy

    Umile Giuseppe Longo

  2. Arthroplasty & Sports Medicine, Nicolaas Institute of Constructive Orthopedic Research, Jakarta, Indonesia

    Nicolaas C. Budhiparama

  3. Département de Chirurgie Orthopédiq, Hôpital de la Croix-Rousse, Lyon Cedex 04, France

    Sébastien Lustig

  4. Department of Orthopaedics and Traumatology, Center of Joint Replacement, Medical Director of the University Hospital, University of Brandenburg an der Havel, Brandenburg, Germany

    Roland Becker

  5. Clínica do Dragao - Espregueira-Mendes, Braga, Portugal

    João Espregueira-Mendes

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Budhiparama, N.C., Santoso, A., Hidayat, H., Ifran, N.N. (2022). DAIR (Debridement, Antibiotics, and Implant Retention) for the Treatment of Periprosthetic Joint Infection of Knee. In: Longo, U.G., Budhiparama, N.C., Lustig, S., Becker, R., Espregueira-Mendes, J. (eds) Infection in Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-030-81553-0_15

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