Periprosthetic joint infection (PJI) represents a complex challenge in orthopaedic surgery associated with substantial morbidity and healthcare expenditures. The debridement, antibiotics, and implant retention (DAIR) protocol is a viable treatment, offering several advantages over exchange arthroplasty. With the evolution of treatment strategies, considerable efforts have been directed towards enhancing the efficacy of DAIR, including the development of a phased debridement protocol for acute PJI management. This article provides an in-depth analysis of DAIR, presenting the outcomes of single-stage, two-stage, and repeated DAIR procedures. It delves into the challenges faced, including patient heterogeneity, pathogen identification, variability in surgical techniques, and antibiotics selection. Moreover, critical factors that influence the decision-making process between single- and two-stage DAIR protocols are addressed, including team composition, timing of the intervention, antibiotic regimens, and both anatomical and implant-related considerations. By providing a comprehensive overview of DAIR protocols and their clinical implications, this annotation aims to elucidate the advancements, challenges, and potential future directions in the application of DAIR for PJI management. It is intended to equip clinicians with the insights required to effectively navigate the complexities of implementing DAIR strategies, thereby facilitating informed decision-making for optimizing patient outcomes.

中文翻译：

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优化急性假体周围关节感染的清创和植入物固位。


假体周围关节感染 （PJI） 是骨科手术中与大量发病率和医疗保健支出相关的复杂挑战。清创、抗生素和植入物保留 （DAIR） 方案是一种可行的治疗方法，与置换关节置换术相比具有多项优势。随着治疗策略的演变，人们已经付出了相当大的努力来提高 DAIR 的疗效，包括开发用于急性 PJI 管理的分阶段清创方案。本文对 DAIR 进行了深入分析，介绍了单阶段、双阶段和重复 DAIR 程序的结果。它深入探讨了面临的挑战，包括患者异质性、病原体鉴定、手术技术的可变性和抗生素选择。此外，还解决了影响单阶段和两阶段 DAIR 方案之间决策过程的关键因素，包括团队组成、干预时间、抗生素方案以及解剖学和植入物相关考虑因素。通过全面概述 DAIR 方案及其临床意义，本注释旨在阐明 DAIR 在 PJI 管理中的应用中的进步、挑战和潜在的未来方向。它旨在为临床医生提供有效驾驭实施 DAIR 策略的复杂性所需的洞察力，从而促进明智的决策以优化患者结果。