477 posters, 14 topics, 2,065 authors, 1,055 institutions

The Joint EBJIS-MSIS 2026 Conference

17 - 19 September, 2026 | Porto, Portugal

PP55

A Comparative analysis of DAIR and Repeat Two-Stage Exchange in Recurrent Periprosthetic Joint Infections following Complex Revision Total Knee Arthroplasty

Preview of A Comparative analysis of DAIR and Repeat Two-Stage Exchange in Recurrent Periprosthetic Joint Infections following Complex Revision Total Knee Arthroplasty

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Poster Presenter

Andrew Gordon

Authors

Andrew Gordon, Samuelson E. Osifo, Adrian Santana, Patrick Pallito, Micheal F. Shannon, Andrew J. Frear, Victoria R. Wong, Niosha Parvizi, Christian Cisneros, Akeem Williams, Kenneth L. Urish

Affiliations

University of Pittsburgh School of Medicine, Pittsburgh, United States, University of Pittsburgh, Pittsburgh, United States, UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE, University of Pittsburgh, Pittsburgh, United States; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States, Boss Orthopedics, Bluffton and Hilton Head Island, United States, Department of Orthopedic Surgery, West Virginia University,, Morgantown, West Virginia, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania; Department of Medicine, Pittsburgh, United States

Part of Topic

Prosthetic Joint Infections

Introduction

Periprosthetic joint infection (PJI)I is the most common cause of failure in both primary and revision total knee arthroplasty (rTKA)[1], and is a significant source of mortality, morbidity, and healthcare expense [2]. Debridement, Antibiotics, and implant retention (DAIR) and two-stage exchange are common treatments for PJIs [3,4]. Two-stage exchange remains a common treatment strategy for chronic PJI [5]; however, this approach may be suboptimal when implant removal complicates reconstruction or limits future reconstructive options.

Methods

Retrospective study of patients treated for recurrent TKA PJI from 2011-2022. Data collected through electronic medical records (EMR). Complex revision defined as use of metaphyseal sleeve, trabecular metal cone, or structural allograft. Patients stratified into two groups: Two-stage exchange with complex revision components or DAIR with long-term antibiotic suppression. Primary outcome: failure, defined as reoperation for PJI within 3 years (MSIS ORT Tier 3 or 4). Kaplan-Meier analysis used to evaluate failure rates

Results

Cohort: 40 patients included; 27 DAIR, 13 repeat two-stage exchange, mean follow-up 25.2 ± 14.2 for DAIR and 34.8 ± 31.0 months for two-stage exchange. Survival analysis revealed no significant difference in overall failure between DAIR and two-stage exchange (80.0% vs 64.1%, respectively, P = 0.23)

Conclusion

DAIR demonstrated a higher cumulative failure rate at 2 years, despite no significant difference in overall failure-free survival. Group size disparity likely reflects surgeon preference for managing complex cases. Larger studies needed to determine optimal treatment approach for recurrent PJI