Bone loss and necrosis of soft tissues also contributed. Major factor associated with treatment failure was compromised immune status. We, therefore, present a thorough review of literature for role of the DAIR procedure as a treatment option for infected TKA. The literature consists of various retrospective series both in Orthopaedic and Microbiology journals with variable opinions over each aspect of DAIR. There are no randomized controlled or prospective trials. Their aim is to retain the implant and to avoid further more invasive/complex surgery. Some surgeons prefer to perform debridement of the knee, particularly in the case of acute infection, to reduce the infective organism load and supplement debridement with systemic antibiotics. ![]() Implant retention without infection is the ideal end result of treatment for an infected total knee arthroplasty. This poses risk of significant damage to the remaining bone stock, making reconstruction difficult with increased risk of perioperative and postoperative complications and potentially compromising the soft tissue envelope. There are significant challenges for the surgeon in removing a well-fixed prosthesis with removal of bone cement. Two operations with a substantial period of reduced mobility and significant anaesthetic and surgical risks are major concerns for the patient. However, it poses significant challenges to both patient and surgeon. ![]() Two-stage revision arthroplasty is considered the gold standard for an infected prosthesis. Prosthetic joint infection (PJI) surgery also poses significant cost implications as it could require multiple procedures, prolonged antibiotics, lengthy hospital stays and more expensive implants for revision surgery. The surgical options include washout, debridement, antibiotics and implant retention (DAIR), one- or two-stage revision total knee arthroplasty, arthrodesis and amputation. The treatment options for an infected total knee arthroplasty (TKA) are usually surgical as antibiotics in isolation are not an appropriate treatment unless there is significant co-morbidity providing a relative contra-indication for surgery. It is, however, one of the most dreaded complications for orthopaedic surgeons because of significant morbidity and because of the surgical challenges it poses. According to the National Joint Registry report of 2013, 22% of revision procedures were performed for infection and according to the National Joint Registry report of 2014 infection is the third most common cause of revision after aseptic loosening and pain with 1.06 revision per 1000 patient-years. Knee replacement is an effective procedure for end-stage knee arthritis. ![]() In conclusion DAIR can be successful procedure to eradicate infection in TKA in selective patients with factors contributing to failure taken into account. The important factors contributing to failure are presence of sinus, immunocompromised patient, delay between onset of infection and debridement procedure, Staphylococcal infection in particular Meticillin Resistant Staphylococcal aureus, multiple debridement procedures, retention of exchangeable components and short antibiotic duration. We present a thorough literature review of DAIR for infected TKA. Implant retention without infection is ideal and DAIR has been reported to have variable success rates depending on patient factors, duration of infection, infecting micro-organisms, choice of procedure, single or multiple debridement procedures, arthroscopic or open, antibiotic choice and duration of antibiotic use. Treatment options include non-operative measures with long term antibiotic suppression, debridement and implant retention (DAIR), one- or two-stage revision arthroplasty, arthrodesis and amputation. Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) and third most common cause of revision of TKA with significant morbidity and surgical challenges.
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