Debridement, Antibiotics and Implant Retention: Are all approaches to periprosthetic joint infection equal? Same procedures, different outcomes.

Background
The reported success rate of debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection varies considerably between studies, despite institutions reporting use of the same procedure. In this narrative review, we aim to delineate the differences between the various DAIR approaches and highlight why they influence the outcome.
Objectives
We performed a PubMed and internet search investigating the different approaches for DAIR and their associated outcomes.
Sources
Twenty-two studies with defined infection criteria, consisting of 50 or more PJI cases and a follow-up of one year or longer were included.
Content
Most studies did not report whether the presence of a sinus tract was a criterion for not performing DAIR, and the use of biofilm-active agents for curative DAIR was only reported in a few studies. The duration of infection as criterion for early postoperative and acute hematogenous infection varied between studies. The epidemiology of host factors and microorganisms, healthcare systems, patient-doctor-interactions and decision-making processes for surgical interventions vary worldwide, and so do the indications for DAIR.
Implications
Studies should precisely declare the indication for DAIR, the variables that influence decision-making for treatment options, the surgical technique applied and the type and duration of antimicrobial therapy. Such an approach will increase the quality of research data and allow the development of recognized subcategories of DAIR.