Debridement, antibiotics, and implant retention (DAIR) is a common treatment option for hip periprosthetic joint infection (PJI). However, noninfectious outcomes of DAIR such as instability are not well reported. The purpose of this study was to evaluate risk factors for hip dislocation post-DAIR for PJI of both primary and revision total hip arthroplasty (THA). A retrospective chart review identified all patients who underwent DAIR of a primary or revision THA over a 20-year period with a minimum 1-year follow-up. A total of 151 patients met inclusion criteria, 19.9% of whom had a post-DAIR dislocation. Demographic and intraoperative variables were obtained. Patients who had modular components exchanged during DAIR to those with increased offset, increased “jump distance”, or a more stable acetabular liner were defined as patients who had “components exchanged to increase stability.” Predictors of hip dislocation post-DAIR were inserted into a multivariate linear regression. Post-DAIR dislocation rates were 16.3% in primary THAs and 25.4% in revision THAs. In patients who had “components exchanged to increase stability” during hip DAIR, there was at least an 11-fold reduction (1/odds ratio (OR), 0.09) in dislocation risk compared to patients who had no components altered during modular component exchange during hip DAIR (OR, 0.09; 95% confidence interval, 0.02-0.44; < .001), while a 13-fold increased dislocation risk was seen in patients with a history of neuromuscular disease (OR, 13.45; 95% confidence interval, 1.73-104.09; = .01). During DAIR of hip PJI, surgeons should consider prophylactically exchanging components to increase stability even if components appear stable intraoperatively.

中文翻译：

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髋关节假体周围感染清创、抗生素和植入物保留后脱位

清创、抗生素和植入物保留 (DAIR) 是髋关节假体周围关节感染 (PJI) 的常见治疗选择。然而，DAIR 的非感染性后果（例如不稳定）尚未得到充分报道。本研究的目的是评估初次和翻修全髋关节置换术 (THA) 的 PJI 后 DAIR 后髋关节脱位的危险因素。一项回顾性图表审查确定了所有在 20 年内接受 DAIR 初次或翻修 THA 并至少随访 1 年的患者。共有 151 名患者符合纳入标准，其中 19.9% 患有 DAIR 后脱位。获得了人口统计学和术中变量。在 DAIR 期间将模块化部件更换为偏移量增加、“跳跃距离”增加或更稳定的髋臼衬垫的患者被定义为“更换部件以提高稳定性”的患者。将 DAIR 后髋关节脱位的预测因子插入多元线性回归中。 DAIR 后初次 THA 脱位率为 16.3%，翻修 THA 脱位率为 25.4%。在髋关节 DAIR 期间“更换部件以提高稳定性”的患者中，与在模块化部件更换期间未更换部件的患者相比，脱位风险至少降低了 11 倍（1/优势比 (OR)，0.09）髋关节 DAIR 期间（OR，0.09；95% 置信区间，0.02-0.44；< .001），而有神经肌肉疾病史的患者脱位风险增加 13 倍（OR，13.45；95% 置信区间， 1.73-104.09；= .01)。在髋部 PJI 的 DAIR 期间，即使部件在术中表现稳定，外科医生也应考虑预防性更换部件以提高稳定性。