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This retrospective study investigated risk factors for DAIR failure in 90 patients with acute PJI, finding an 85.6% success rate. Multivariate analysis identified acute hematogenous infection, elevated preoperative CRP, high synovial fluid PMN%, and resistant pathogens as independent risk factors for DAIR failure, which were then used to develop a predictive nomogram. The study included both hip and knee arthroplasties.
Hematogenous infection, elevated CRP and PMN%, and resistant organisms are independently associated with DAIR failure in acute PJI, allowing for risk stratification using a new nomogram.
Objective Debridement, antibiotics, and implant retention (DAIR) is the preferred treatment for acute periprosthetic joint infection (PJI), yet its failure rate remains high, and the influencing factors are not fully elucidated. This study aimed to investigate the causes of DAIR failure in acute PJI and construct a risk prediction model based on clinical characteristics, inflammatory markers, and microbiological data. Methods A retrospective analysis was conducted on 90 patients with acute PJI treated at our medical center between January 2008 and April 2024. All patients underwent standard DAIR treatment and were categorized into success (n = 77) and failure (n = 13) groups based on outcomes. Demographic data, infection characteristics, laboratory markers, microbiological results, and surgical details were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, and a nomogram prediction model was developed. Results The overall success rate of DAIR was 85.6% (77/90). The failure group exhibited significantly higher rates of knee joint infection (84.6% vs. 50.6%, p=0.023), acute hematogenous infection (61.5% vs. 20.8%, p=0.005), preoperative peripheral White Blood Cell (WBC) (9.5ร10^9/L vs. 8.2ร10^9/L, p=0.043), CRP (79.6โ4 mg/L vs. 42.4 mg/L, p<0.001), ESR (80.6 mm/h vs. 60.5 mm/h, p=0.002), synovial fluid WBC (35,300ร10^6/L vs. 21,843ร10^6/L, p=0.043), and synovial fluid polymorphonuclear leukocytes (PMNs) (91.7% vs. 83.8%, p<0.001) compared to the success group. Multivariate logistic regression identified acute hematogenous infection (OR 11.704, 95% CI 1.957โ119.357, p=0.015), preoperative CRP (OR 1.022, 95% CI 1.009โ1.040, p=0.003), synovial fluid PMN% (OR 1.196, 95% CI 1.039โ1.454, p=0.039), and resistant pathogens (OR 0.107, 95% CI 0.010โ0.665, p=0.032) as independent risk factors for DAIR failure. The nomogram model based on these factors demonstrated robust predictive performance. Conclusion DAIR failure is closely associated with hematogenous infection, the intensity of inflammatory response, and the presence of resistant pathogens. The proposed risk prediction model may aid clinical decision-making and optimize patient selection for DAIR.
