Abstract
Objectives
The primary objective of the study was to evaluate the efficiency of KLIC and CRIME80 scores in assessing the risk of failure of the Debridement, Antibiotics and Implant Retention (DAIR) procedure for the treatment of acute postoperative periprosthetic joint infection after total knee arthroplasty (TKA). Secondary objectives included determining the failure rate of DAIR and identifying factors related to DAIR treatment failure.
Methods
A retrospective study was conducted with patients undergoing DAIR within 30 days post-TKA or TKA revision at a specialized SUS hospital for high-complexity orthopedic surgeries. Patient records were evaluated to collect the necessary information for score assessment. Procedure failures were considered if re-intervention was required within 60 days, death occurred within 60 days, or if suppressive antibiotic therapy was needed.
Results
The study included 17 patients undergoing the DAIR procedure. 52% of infections were caused by Staphylococcus aureus, and 29% occurred after revision surgery. Six (35%) patients experienced DAIR failure, and the mortality rate was 11%. Patients who failed had a higher score on the KLIC score (p<0.0001). Regarding the CRIME80 score, only 33% of those with a score of less than 3 experienced procedure failure. Results also showed that for patients with a KLIC score between 2,5 and 5, the presence of a comorbidity or risk factor resulted in DAIR failure. Additionally, 100% of patients with chronic kidney disease experienced treatment failure, with 66% of them progressing to death.
Conclusion
Our results demonstrated that the KLIC and CRIME80 scores proved to be effective methods in predicting the likelihood of failure in the treatment of acute postoperative periprosthetic joint infection with DARI and patients in intermediate KLIC groups with comorbidities are subject to a higher chance of failure.