CORR Insights®: Lower Success Rate of Débridement and Implant Retention in Late Acute Versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study.

In the current study, WouthuyzenBakker et al. [23] present an international, multicenter review of patients with periprosthetic joint infection (PJI) who were treated with débridement and implant retention (DAIR). The authors suggest successful treatment is more likely with early, as opposed to late, acute PJI, particularly when the identified pathogen is Staphylococcus spp. In recent years, the parameters that must exist in order for DAIR tobe effectivehavebecomeclearer, and this paper continues that theme. Certainly, the appeal of DAIR as a less-morbid alternative to two-stage revision diminishes when substandard conditions jeopardize the outcome. This paper [23] represents the latest in a number of recent publications [1, 7] that characterize the likelihood of infection eradication among highly specific groups or subsets of patients with PJI. Becker et al. [1] recently suggested that the addition of rifampin reduces the likelihood of persistent infection and reoperation in patients with early acute staphylococcus spp. PJI. A retrospective analysis by Ji et al. [7] showed that when added to single-stage exchange, intraarticular antibiotic infusion was associated with improved patient reported outcomes, but no difference in infection control rate for treatment of culture negative PJI. These are just a few examples that provide associative guidance for treatment of PJI when a specific cluster of conditions is met. Recent progress in diagnostic testing has helped us to identify patients with PJI with greater precision [3, 11]. This is of great importance considering how different the care of a patient with PJI is compared to the care of a patient who has a painful arthroplasty that is not infected. Even when novel tests fall short of changing the diagnostic paradigm of PJI, they may still offer prognostic value [9, 14, 18]. Historically, classifications throughout medicine have sought to transform complex collections of data into simple codified categories that are more easily interpreted by the human brain. In fact, we are likely to gripe and dismiss any classification system as unnecessarily complicated if the proposed is incapable of distilling data into some variation of “good”, “bad”, and “really bad”. Regarding PJI, our scope of knowledge has expanded exponentially. This has rendered the traditional classifications [12, 13, 21] less comprehensive than they once seemed to be, though certainly still relevant. Likewise, the algorithmic manner in which we approach PJI is likely an oversimplification of a complex web of interrelated factors of uncertain consequence when considering the unique presentation of an individual patient. As we continue to break down PJI into more specific categorizations and subsets of subsets, how do we This CORR Insights is a commentary on the article “Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study” by Wouthuyzen-Bakker and colleagues available at: DOI: 10.1097/CORR. 0000000000001171. The author is supported in part by a grant from the US NIH (R01AG058878). The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons.