Failed DAIR and reinfection risk after two-stage revision
Clinical Orthopaedics and Related Research · 23 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Choosing between DAIR and going straight to implant removal is a core PJI decision, and this study suggests a failed DAIR may compromise the later two-stage revision, especially when DAIR is used outside its accepted acute indications.
The evidence
This Spanish 12-hospital case-control study looked at adults who had a two-stage revision for an infected hip, knee, or shoulder replacement and asked whether those who first had a failed DAIR (debridement, antibiotics, and implant retention) were more likely to get reinfected within 2 years. Among 89 reinfected cases and 171 matched controls, a prior failed DAIR was linked to about 3.5 times higher adjusted odds of reinfection (OR 3.5, 95% CI 1.4 to 8.8). The association looked stronger in chronic infections (OR 4.0) than acute ones (OR 2.2), but the interaction test was not significant.
Prosthetic joint reinfection within 2 years of reimplantation: Odds ratio 3.5 (95% CI 1.4 to 8.8; ratio). The interval favours the comparator; the size of the disadvantage needs clinical interpretation.
Why this rigour score?
Case-controlDesign starting point: 27
Raised the score
- Compared against current standard of care+3.4
- Aligned time zero+2.5
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 27
- Aligned time zero
- +2.5
- Compared against current standard of care
- +3.4
- Consecutive enrolment
- +2.5
- Journal prior (not an observed method)
- +1.9
- Final rigour score rounded
- 37 / 100
Study design sets the starting point and a ceiling of 66. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.For a patient with a chronic or late PJI, how should a possible higher reinfection risk after failed DAIR change the decision to attempt implant retention rather than proceed directly to two-stage revision?
2.How would you counsel a patient with an acute PJI about the trade-off between keeping the implant with DAIR and the risk that a failed DAIR could make a later two-stage revision less likely to succeed?
Original publication title
Does a Prior Unsuccessful DAIR Increase the Risk of Reinfection After a Two-stage Revision for Periprosthetic Joint Infection? Results of a Multicenter Case-control Study