The aims of the study were to review and analyse the reported series of debridement, antibiotics and implant retention (DAIR) in the management of infected total hip replacements (THRs) to establish the overall success and the influencing factors.
Patients and methods
Using a standardised and recognised study protocol (“Meta-analysis of observational studies in epidemiology (MOOSE) guidelines) a comprehensive review and analysis of the literature was performed. The primary outcome measure of interest was treatment success. The search strategy and inclusion criteria plus quality assessment yielded 39 articles eligible for analysis, which included 1296 patients.
The proportion of success from the literature following DAIR in the management of infected THRs appeared to have improved since 2004 with a pooled mean proportion of success of 72.2%. For all reported series, from 1977 onwards, there was improved success with early debridement (< seven days) (75.7%) and exchange of modular components (77.5%). There was a statistically non-significant improvement if debridement was performed within four weeks of the original surgery (73.0%).
The reported success following DAIR has improved since 2004. The only determinants of outcome found by this review were the timing of debridement from onset of symptoms and the exchange of modular components.
Take home message
A DAIR procedure, with exchange of modular components should be considered for acutely infected THR when presenting within seven days from the onset of symptoms. Future cohorts should include a core outcome set of relevant data for future meta-analyses.