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Objective <p>Debridement, antibiotics, and implant retention (DAIR) is a widely used surgical approach for managing acute prosthetic joint infection (PJI) following knee arthroplasty (KA). However, limited studies have explored its application across different KA types. This study aims to compare the clinical outcomes of DAIR in acute PJI following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), with a focus on microbial profiles, treatment characteristics, and patient outcomes.</p> Methods <p>We retrospectively reviewed clinical data from 67 consecutive patients diagnosed with acute PJI, as defined by the Musculoskeletal Infection Society (MSIS) criteria, who underwent DAIR at our institution between January 2016 and April 2023. Patients were categorized into two groups based on the type of primary arthroplasty: 51 in the TKA-DAIR group and 16 in the UKA-DAIR group. Comparative analyses included pre- and postoperative serological inflammatory markers, microbiological findings, knee functional outcomes, and infection recurrence rates.</p> Results <p>Coagulase-negative staphylococci were the most frequently isolated organisms in both the TKA-DAIR (37.3%) and UKA-DAIR (43.8%) groups. On postoperative day one, ESR and CRP levels showed no significant differences between groups. However, by postoperative day three, the UKA-DAIR group exhibited significantly lower ESR (<i>P</i> = 0.005) and CRP (<i>P</i> = 0.007) levels, a trend that persisted through day five (ESR, <i>P</i> = 0.014; CRP, <i>P</i> = 0.015). At two year follow-up, there were no significant differences between groups in HSS knee scores (<i>P</i> = 0.107), VAS pain scores (<i>P</i> = 0.531), or range of motion (ROM; <i>P</i> = 0.128). Notably, Kaplan-Meier survival analysis demonstrated a significantly lower infection recurrence rate in the UKA-DAIR group over the two year follow-up period (<i>P</i> = 0.041).</p> Conclusion <p>In cases of acute PJI following UKA, where MRI confirms that the contralateral compartment remains uninvolved and the causative pathogen is clearly identified, DAIR yields superior clinical outcomes compared to TKA. This may be attributed to the reduced prosthetic surface area in UKA and the retention of native cartilage, which may serve as an effective barrier against infection. Based on these findings, we recommend DAIR as the preferred treatment strategy for acute UKA PJI under these conditions.</p>

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Clinical outcomes of debridement, antibiotics, and implant retention in acute prosthetic joint infection: unicompartmental knee arthroplasty vs. total knee arthroplasty

  • 期刊论文

  • 发表日期：

    2025年10月29日

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  • Lan Lin,
  • Yuntao Liao,
  • Baijian Wu,
  • Juncheng Li,
  • Zhenyuan Lin,
  • Zida Huang,
  • Wenming Zhang,
  • Zeyu Zhang,
  • Chengguo Huang,
  • Wenbo Li,
  • Xinyu Fang

摘要

Objective

Debridement, antibiotics, and implant retention (DAIR) is a widely used surgical approach for managing acute prosthetic joint infection (PJI) following knee arthroplasty (KA). However, limited studies have explored its application across different KA types. This study aims to compare the clinical outcomes of DAIR in acute PJI following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), with a focus on microbial profiles, treatment characteristics, and patient outcomes.

Methods

We retrospectively reviewed clinical data from 67 consecutive patients diagnosed with acute PJI, as defined by the Musculoskeletal Infection Society (MSIS) criteria, who underwent DAIR at our institution between January 2016 and April 2023. Patients were categorized into two groups based on the type of primary arthroplasty: 51 in the TKA-DAIR group and 16 in the UKA-DAIR group. Comparative analyses included pre- and postoperative serological inflammatory markers, microbiological findings, knee functional outcomes, and infection recurrence rates.

Results

Coagulase-negative staphylococci were the most frequently isolated organisms in both the TKA-DAIR (37.3%) and UKA-DAIR (43.8%) groups. On postoperative day one, ESR and CRP levels showed no significant differences between groups. However, by postoperative day three, the UKA-DAIR group exhibited significantly lower ESR (P = 0.005) and CRP (P = 0.007) levels, a trend that persisted through day five (ESR, P = 0.014; CRP, P = 0.015). At two year follow-up, there were no significant differences between groups in HSS knee scores (P = 0.107), VAS pain scores (P = 0.531), or range of motion (ROM; P = 0.128). Notably, Kaplan-Meier survival analysis demonstrated a significantly lower infection recurrence rate in the UKA-DAIR group over the two year follow-up period (P = 0.041).

Conclusion

In cases of acute PJI following UKA, where MRI confirms that the contralateral compartment remains uninvolved and the causative pathogen is clearly identified, DAIR yields superior clinical outcomes compared to TKA. This may be attributed to the reduced prosthetic surface area in UKA and the retention of native cartilage, which may serve as an effective barrier against infection. Based on these findings, we recommend DAIR as the preferred treatment strategy for acute UKA PJI under these conditions.