{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:17:57Z","timestamp":1785403077075,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100030943","name":"Chosun University Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100030943","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/0131gn249","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication associated with substantial morbidity and healthcare costs. Although two-stage revision arthroplasty is widely accepted as a standard treatment, debridement, antibiotics, and implant retention (DAIR) is frequently attempted as a less invasive initial strategy. However, the impact of failed DAIR on the outcomes of subsequent two-stage revision remains controversial. Methods: This retrospective cohort study included patients who underwent two-stage revision arthroplasty for PJI following TKA at a single institution between 2005 and 2019, involving 84 knees at an average follow-up of 5.1 \u00b1 3.3 years. Outcomes were compared between patients with a history of failed DAIR (F-DAIR group, n = 23) and those who underwent direct two-stage revision without prior procedures (DTSR group, n = 61). Treatment failure rates and associated risk factors were analyzed. Results: There was no significant difference in treatment failure rates between the F-DAIR and DTSR groups (4.3% vs. 9.8%, respectively; p = 0.668). Cox regression suggested that PJI type (acute vs. chronic) and diabetes mellitus were associated with treatment failure. Conclusions: In this retrospective cohort, prior failed DAIR was not associated with a statistically significant reduction in the success of subsequent two-stage revision arthroplasty. These findings may support consideration of DAIR as an initial treatment option in carefully selected patients; however, cautious interpretation is warranted because of the retrospective design, limited sample size, baseline imbalance, and small number of failure events. Therefore, the findings should be considered hypothesis-generating rather than definitive comparative evidence.<\/jats:p>","DOI":"10.3390\/jcm15124563","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T09:49:51Z","timestamp":1781257791000},"page":"4563","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Failed Debridement, Antibiotics, and Implant Retention on Subsequent Two-Stage Reimplantation for Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Dong Hwi","family":"Kim","sequence":"first","affiliation":[{"name":"College of Medicine, Chosun University, Gwangju 61452, Republic of Korea"},{"name":"Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GwangChul","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Medicine, Chosun University, Gwangju 61452, Republic of Korea"},{"name":"Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8030-3639","authenticated-orcid":false,"given":"Ba Woo","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hwan","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Daejung Hospital, Gwangju 61473, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3378-5954","authenticated-orcid":false,"given":"Suenghwan","family":"Jo","sequence":"additional","affiliation":[{"name":"College of Medicine, Chosun University, Gwangju 61452, Republic of Korea"},{"name":"Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1086\/502033","article-title":"The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: Adverse quality of life, excess length of stay, and extra cost","volume":"23","author":"Whitehouse","year":"2002","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3238","DOI":"10.1016\/j.arth.2018.05.042","article-title":"Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population","volume":"33","author":"Kurtz","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1056\/NEJMra040181","article-title":"Prosthetic-joint infections","volume":"351","author":"Zimmerli","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1128\/CMR.00111-13","article-title":"Prosthetic joint infection","volume":"27","author":"Tande","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1080\/17453670902805064","article-title":"Outcome of prosthesis exchange for infected knee arthroplasty: The effect of treatment approach","volume":"80","author":"Jamsen","year":"2009","journal-title":"Acta Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11999-010-1434-1","article-title":"The Chitranjan Ranawat Award: Fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic knee infection","volume":"469","author":"Sherrell","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cis803","article-title":"Diagnosis and management of prosthetic joint infection: Clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1080\/17453670610012719","article-title":"Antibiotic-impregnated PMMA hip spacers: Current status","volume":"77","author":"Anagnostakos","year":"2006","journal-title":"Acta Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1093\/jac\/dkp107","article-title":"One hundred and twelve infected arthroplasties treated with \u2019DAIR\u2019 (debridement, antibiotics and implant retention): Antibiotic duration and outcome","volume":"63","author":"Byren","year":"2009","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1111\/j.1469-0691.2010.03333.x","article-title":"Early prosthetic joint infection: Outcomes with debridement and implant retention followed by antibiotic therapy","volume":"17","author":"Cobo","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/j.1469-0691.2011.03693.x","article-title":"Short-course antibiotics for prosthetic joint infections treated with prosthesis retention","volume":"18","author":"Puhto","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.arth.2010.01.104","article-title":"Irrigation and debridement in the management of prosthetic joint infection: Traditional indications revisited","volume":"25","author":"Azzam","year":"2010","journal-title":"J. Arthroplast."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.jinf.2018.08.017","article-title":"Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes","volume":"77","author":"Kunutsor","year":"2018","journal-title":"J. Infect."},{"key":"ref_14","first-page":"3459","article-title":"KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics","volume":"473","author":"Tornero","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1302\/0301-620X.99B5.BJJ-2016-0562.R2","article-title":"Functional outcome of debridement, antibiotics and implant retention in periprosthetic joint infection involving the hip: A case-control study","volume":"99","author":"Grammatopoulos","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.arth.2015.08.044","article-title":"Irrigation and debridement before a 2-stage revision total knee arthroplasty does not increase risk of failure","volume":"31","author":"Brimmo","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.1016\/j.arth.2017.03.026","article-title":"The influence of a failed irrigation and debridement on the outcomes of a subsequent 2-stage revision knee arthroplasty","volume":"32","author":"Nodzo","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2588","DOI":"10.1016\/j.arth.2018.02.087","article-title":"Does prior failed debridement compromise the outcome of subsequent two-stage revision done for periprosthetic joint infection following total knee arthroplasty?","volume":"33","author":"Rajgopal","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1007\/s00167-019-05476-5","article-title":"Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection","volume":"27","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.arth.2019.01.066","article-title":"Failed debridement and implant retention does not compromise the success of subsequent staged revision in infected total knee arthroplasty","volume":"34","author":"Kim","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.arth.2016.03.028","article-title":"Risk of reinfection after treatment of infected total knee arthroplasty","volume":"31","author":"Cochran","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1302\/0301-620X.102B12.BJJ-2020-0792.R1","article-title":"The actual success rate of the two-stage exchange arthroplasty strategy in chronic periprosthetic joint infection","volume":"102-B","author":"Corona","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: From the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria","volume":"33","author":"Parvizi","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1","article-title":"The EBJIS definition of periprosthetic joint infection","volume":"103","author":"McNally","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.arth.2014.03.009","article-title":"International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection","volume":"29","author":"Parvizi","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.2106\/JBJS.19.00062","article-title":"Definition of successful infection management and guidelines for reporting of outcomes after surgical treatment of periprosthetic joint infection: From the Workgroup of the Musculoskeletal Infection Society (MSIS)","volume":"101","author":"Fillingham","year":"2019","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1016\/0895-4356(95)00048-8","article-title":"Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates","volume":"48","author":"Peduzzi","year":"1995","journal-title":"J. Clin. Epidemiol."},{"key":"ref_30","first-page":"9195","article-title":"Impact of prior failed irrigation and debridement on outcomes of subsequent two-stage revision arthroplasty: A systematic review and meta-analysis","volume":"26","author":"Tan","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_31","first-page":"51","article-title":"Two-stage reimplantation in periprosthetic knee infection","volume":"23","author":"Vasso","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e8805","DOI":"10.1097\/MD.0000000000008805","article-title":"Is hemoglobin A1c and perioperative hyperglycemia predictive of periprosthetic joint infection following total joint arthroplasty? A systematic review and meta-analysis","volume":"96","author":"Yang","year":"2017","journal-title":"Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S263","DOI":"10.1016\/j.arth.2017.04.065","article-title":"Determining the threshold for HbA1c as a predictor for adverse outcomes after total joint arthroplasty: A multicenter, retrospective study","volume":"32","author":"Tarabichi","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/jac\/dkh032","article-title":"Release of gentamicin and vancomycin from temporary hip spacers in two-stage revision of infected arthroplasties","volume":"53","author":"Minelli","year":"2004","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.artd.2020.07.009","article-title":"Fate of Two-Stage Reimplantation After Failed Irrigation and Debridement for Periprosthetic Hip Infection","volume":"6","author":"Kavolus","year":"2020","journal-title":"Arthroplast. Today"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1007\/s11999-010-1417-2","article-title":"Can this prosthesis be saved?: Implant salvage attempts in infected primary total knee arthroplasty","volume":"469","author":"Gardner","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.arth.2009.04.028","article-title":"The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components","volume":"24","author":"Bradbury","year":"2009","journal-title":"J. Arthroplast."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4563\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T04:19:01Z","timestamp":1781410741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4563"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124563"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124563","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}