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

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.