{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:25:31Z","timestamp":1787754331118,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study aims to assess how patient comorbidities and risk factors influence treatment outcomes of periprosthetic joint infection (PJI). The role of timing for DAIR intervention, administration of antibiotics, and the microbiological profile in relation to infection recurrence were investigated. Methods: This retrospective study included 58 patients, 26 after total hip arthroplasty (THA) and 32 after total knee arthroplasty (TKA), who underwent surgery for early PJI managed with the complete DAIR protocol at a single academic orthopedic center (Professor Adam Gruca Orthopedic and Trauma Teaching Hospital) between January 2014 and January 2021. A minimum follow-up period after DAIR was five years. Results: In the overall cohort, therapeutic success was achieved in 41 of 58 patients (71%). Treatment of early PJI after THA was successful in 21 of 26 patients (81%), while after TKA, 20 of 32 patients (63%) achieved a favorable outcome. An increase in the number of comorbidities associated with infection risk was correlated with a lower likelihood of successful treatment using the DAIR protocol. Our analysis also demonstrated that the timing from total joint arthroplasty (TJA) to surgical intervention, the administration of antimicrobial therapy, and positive culture results influenced the success rate. Conclusions: The effectiveness of the DAIR protocol in managing early PJI is influenced by multiple factors. This study suggests that crucial determinants include prompt and accurate diagnosis, identification of patient-specific risk factors, the causative pathogen and its antibiotic administration, as well as the timing of intervention.<\/jats:p>","DOI":"10.3390\/jcm15103865","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"3865","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Debridement, Antibiotics, and Implant Retention (DAIR) Protocol for the Management of Early Periprosthetic Joint Infections: An Eight-Year Single-Centre Experience"],"prefix":"10.3390","volume":"15","author":[{"given":"Aleksandra","family":"Grajek","sequence":"first","affiliation":[{"name":"Prof. Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u0142awomir","family":"Chaberek","sequence":"additional","affiliation":[{"name":"Prof. Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1812-7061","authenticated-orcid":false,"given":"Dariusz","family":"Grzelecki","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/os.12641","article-title":"Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection","volume":"12","author":"Zhang","year":"2020","journal-title":"Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.arth.2013.07.021","article-title":"Acute hematogenous infection following total hip and knee arthroplasty","volume":"29","author":"Konigsberg","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"93","DOI":"10.36519\/idcm.2024.332","article-title":"The Incidence and Risk Factors of Early Periprosthetic Joint Infections","volume":"6","year":"2024","journal-title":"Infect. Dis. Clin. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1051\/sicotj\/2016038","article-title":"The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement\u2014A literature review","volume":"3","author":"Qasim","year":"2017","journal-title":"SICOT J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5194\/jbji-6-329-2021","article-title":"Timing of debridement, antibiotics, and implant retention (DAIR) for early post-surgical hip and knee prosthetic joint infection (PJI) does not affect 1-year re-revision rates: Data from the Dutch Arthroplasty Register","volume":"6","author":"Reijman","year":"2021","journal-title":"J. Bone Jt. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhao, A., Sun, J., and Liu, Y. (2023). Understanding bacterial biofilms: From definition to treatment strategies. Front. Cell Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1137947"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1007\/s42770-021-00624-x","article-title":"Microbial biofilm: Formation, architecture, antibiotic resistance, and control strategies","volume":"52","author":"Rather","year":"2021","journal-title":"Braz. J. Microbiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"275","DOI":"10.5604\/15093492.1162427","article-title":"A Retrospective Analysis of Bacteriological Studies of Surgical Site Infections in a Monoprofile, Multidepartmental Orthopedic Hospital","volume":"17","author":"Grajek","year":"2015","journal-title":"Ortop. Traumatol. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1016\/j.arth.2020.12.005","article-title":"Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States","volume":"36","author":"Premkumar","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jisako.2023.09.003","article-title":"Debridement, antibiotics, and implant retention (DAIR) for the early prosthetic joint infection of total knee and hip arthroplasties: A systematic review","volume":"9","author":"Longo","year":"2024","journal-title":"J. ISAKOS"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"42","DOI":"10.21037\/aoj-20-87","article-title":"Contemporary outcomes of debridement, antibiotics and implant retention (DAIR) in hip arthroplasty","volume":"6","author":"Bolduc","year":"2020","journal-title":"Ann. Jt."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1302\/2633-1462.63.BJO-2024-0225.R1","article-title":"The health-economic burden of hip and knee periprosthetic joint infections in Europe: A comprehensive analysis following primary arthroplasty","volume":"6","author":"Alt","year":"2025","journal-title":"Bone Jt. Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/CORR.0000000000003201","article-title":"How Much Does Prosthetic Joint Infection and Its Successful Treatment Affect Patient-reported Quality of Life?","volume":"483","author":"Cooper","year":"2025","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1186\/s13018-025-05531-7","article-title":"The diagnostic accuracy of blood C-reactive protein and erythrocyte sedimentation rate in periprosthetic joint infections\u2014A 10-year analysis of 1510 revision hip and knee arthroplasties from a single orthopaedic center","volume":"20","author":"Grzelecki","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.arth.2025.05.121","article-title":"Efficacy of Debridement, Antibiotics, and Implant Retention in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis","volume":"41","author":"Abbaszadeh","year":"2026","journal-title":"J. Arthroplast."},{"key":"ref_16","first-page":"e98180","article-title":"A Comparison of 1.5-Stage and Two-Stage Revisions for Prosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Meta-Analysis of Outcomes","volume":"17","author":"Ibrahim","year":"2025","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"127","DOI":"10.5194\/jbji-9-127-2024","article-title":"Changing the definition of treatment success alters treatment outcomes in periprosthetic joint infection: A systematic review and meta-analysis","volume":"9","author":"Debbi","year":"2024","journal-title":"J. Bone Jt. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S399","DOI":"10.1016\/j.arth.2023.04.024","article-title":"Success of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infection Following Primary Total Knee Arthroplasty: Results From a Prospective Multicenter Study of 189 Cases","volume":"38","author":"Rahardja","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.arth.2025.07.008","article-title":"Outcome of Debridement, Antibiotics, and Implant Retention for Treatment of Late Acute Hematogenous Periprosthetic Joint Infections","volume":"41","author":"Chandler","year":"2026","journal-title":"J. Arthroplast."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S297","DOI":"10.1016\/j.arth.2025.10.076","article-title":"2025 ICM: Debridement, Antibiotics, and Implant Retention (DAIR)","volume":"41","author":"Cashman","year":"2025","journal-title":"J. Arthroplast."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1093\/cid\/ciz867","article-title":"Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty","volume":"71","author":"Lowik","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"380","DOI":"10.3109\/17453674.2013.823589","article-title":"Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): Analysis of risk factors and local antibiotic carriers in 91 patients","volume":"84","author":"Kuiper","year":"2013","journal-title":"Acta Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/cid\/cis746","article-title":"A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention","volume":"56","author":"Murillo","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1302\/0301-620X.99B11.BJJ-2017-0088.R1","article-title":"Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: A review of cohort studies","volume":"99","author":"Tsang","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1056\/NEJMoa061588","article-title":"Sonication of removed hip and knee prostheses for diagnosis of infection","volume":"357","author":"Trampuz","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1128\/JCM.01686-08","article-title":"Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication","volume":"47","author":"Piper","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1530\/EOR-22-0115","article-title":"Cultures in periprosthetic joint infections, the imperfect gold standard?","volume":"8","year":"2023","journal-title":"EFORT Open Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1016\/j.arth.2024.03.016","article-title":"Differences in Diagnostic Sensitivity of Cultures Between Sample Types in Periprosthetic Joint Infections: A Systematic Review and Meta-Analysis","volume":"39","author":"Watanabe","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Li, H., Xu, C., Hao, L., Chai, W., Jun, F., and Chen, J. (2021). The concordance between preoperative aspiration and intraoperative synovial fluid culture results: Intraoperative synovial fluid re-cultures are necessary whether the preoperative aspiration culture is positive or not. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06721-4"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5194\/jbji-7-259-2022","article-title":"The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: A systematic review","volume":"7","author":"Goosen","year":"2022","journal-title":"J. Bone Jt. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e0060","DOI":"10.2106\/JBJS.OA.17.00060","article-title":"Culture-Negative Periprosthetic Joint Infection: An Update on What to Expect","volume":"3","author":"Tan","year":"2018","journal-title":"JB JS Open Access"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102430","DOI":"10.1016\/j.jcot.2024.102430","article-title":"Culture-negative periprosthetic joint infections: Do we have an issue?","volume":"52","author":"Tsai","year":"2024","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2765","DOI":"10.1128\/JCM.00640-17","article-title":"The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: A Systematic Review","volume":"55","author":"Benito","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S376","DOI":"10.1016\/j.arth.2025.10.079","article-title":"2025 ICM: Antibiotic Prophylaxis in Revision Arthroplasty","volume":"41","author":"Kortlever","year":"2025","journal-title":"J. Arthroplast."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00590-021-03156-0","article-title":"Empiric antibiotic therapy in early periprosthetic joint infection: A retrospective cohort study","volume":"33","author":"Scholten","year":"2023","journal-title":"Eur. J. Orthop. Surg. Traumatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3865\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:03:59Z","timestamp":1779109439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3865"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,17]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103865"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103865","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,17]]}}}