Utilization of Debridement, Antibiotics and Implant Retention for Infection After Total Joint Arthroplasty Over a Decade in the United States

Abstract Background Reported clinical outcomes have varied for debridement, antibiotics, and implant retention (DAIR) and little is known regarding trends in utilization. We sought to evaluate the rate of DAIR utilization for TKA and THA PJI over a decade and clinical factors associated with these trends. Methods A retrospective study of primary TKAs and THAs was performed using Medicare data from 2005 to 2014 using the PearlDiver Database platform. CPT and ICD-9 codes identified patients who underwent a surgical revision for PJI, whether revision was a DAIR, as well as associated clinical factors including timing from index arthroplasty. Results The proportion of revision TKAs and THAs performed using DAIR was 27% and 12% across all years, respectively. This proportion varied by year for TKAs and THAs with a linear trend towards increasing relative use of DAIR estimated at 1.4% and 0.9% per year (P 85 years (P=.04). Conclusion The proportion of revision arthroplasty cases for PJI managed with DAIR has been increasing over time in the United States, with the most substantial increase seen 85 years and in those with a very low ECI score.