Mingzhang Li, Boyong Wang, Zifei Yin, Changming Wang, Deyi Ding, Xiaohua Chen, Hao Shen, Qiaojie Wang
The DVIA technique appears to be a feasible adjunctive strategy for the management of acute PJI, enabling effective local antibiotic delivery and favorable clinical outcomes. These findings are preliminary and warrant further validation in prospective controlled studies.
AIMS: Periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. While debridement, antibiotics, and implant retention (DAIR) are a common treatment for acute PJI, its success rate is variable. Intra-articular antibiotic administration and wound healing techniques may enhance infection control and improve clinical outcomes. This study aimed to describe a modified technique combining DAIR with vacuum sealing drainage (VSD) and intra-articular antibiotic infusion (DVIA) for treating acute PJI, and evaluate its clinical feasibility and preliminary outcomes.
METHODS: This retrospective, single-center case series included 31 patients who underwent DVIA (hip: 19; knee: 12) between September 2019 and December 2023. Following DAIR, a technique integrating vacuum-sealed drainage for wound management with intra-articular antibiotic infusion was applied. Inflammatory markers (CRP, ESR) and intra-articular antibiotic concentrations were monitored at multiple time points. Treatment outcomes, CRP and ESR levels, Knee Society Score (KSS), KSS functional score, Harris Hip Score (HHS), and the 36-item Short-Form (SF-36) physical function scale were evaluated over a 12-month follow-up.
RESULTS: Infection control was achieved in 90.32% (28/31) of patients. CRP and ESR levels decreased after treatment. Joint function and patient-reported physical function improved during follow-up. Intra-articular vancomycin concentrations measured in a subset of patients exceeded previously reported minimum biofilm eradication concentration (MBEC) thresholds. No catheter-related complications, retrograde infections, or systemic antibiotic-related adverse events were observed.
CONCLUSION: The DVIA technique appears to be a feasible adjunctive strategy for the management of acute PJI, enabling effective local antibiotic delivery and favorable clinical outcomes. These findings are preliminary and warrant further validation in prospective controlled studies.