When and How to Retain Implants in Periprosthetic Joint Infection

Debridement, antibiotics, and implant retention (DAIR) is an evolving treatment option for periprosthetic joint infection (PJI). Modern treatment includes a variety of surgical protocols and further utility in non-traditional cases, including chronic PJI with unresectable prosthesis. From a technical perspective, DAIR execution is directed to decrease bioburden intraoperatively, and newer adjuvants include intraoperative disinfectants, the staged DAIR procedure, and intraosseous antibiotics. The authors prefer a "double draping" setup, thorough debridement, intraosseous antibiotic administration, multi-solution irrigation, and staging for a second DAIR procedure when appropriate. Postoperative care with negative pressure wound therapy is often utilized for healing and protective benefits while antibiotics are directed by cultures. Chronic suppressive therapy is often implemented. As DAIR efficacy improves and indications broaden, its clinical utility continues to expand. (C) 2021 Elsevier Inc. All rights reserved.